Beyond High-Density Mapping: Is There a Gold Medalist?*

摘要

The quest for a 100% success rate in ventricular tachycardia (VT) ablation is driving a large JL body of research to improve the techniques we use for mapping to decide our ablation targets. Comparing old technologies with newer ones is a fundamental way of moving the field forward. One of the critical issues that newer mapping tools and catheter designs need to solve is providing the most physiological depiction of the underlying substrate, that is, to deliver a comprehensive and reproducible electrical picture of the myocardium being mapped at each beat. In that sense, multielectrode mapping has been responsible for an important step forward. But not all multielectrode mapping tools are created equal, and catheter design is of paramount importance when trying to solve one of the main issues that affect our ability to map the myocardium: the directional dependency of the angle of the wave front being mapped with respect to our bipolar electrodes. In silico works and pre-clinical and clinical data have shown us that no matter how closely spaced a pair of bipoles, the directional dependency of the signal being mapped will always be relevant (1-4), apart from the inherent tissue anisotropy. To tackle this issue, among others, a grid catheter with orthogonal pairs of electrodes was designed.