Role of Octaspline Multielectrode Catheter and Unipolar Reference Location for Premature Ventricular Contraction Ablation

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Abstract
Background: An accurate local activation time (LAT) map is essential during premature ventricular contraction (PVC) ablation. The aim of this study was to evaluate whether the use of a novel octaspline multielectrode catheter, with and without the use of a catheter‐embedded unipolar reference, improves LAT mapping during PVC ablation compared to a pre‐existing pentaspline mapping catheter. Methods: This study prospectively assessed 10 consecutive patients referred for PVC ablation from January to June 2023. Three 12‐min LAT maps were performed in each patient using three different strategies: pentaspline catheter + unipolar reference in the inferior vena cava (IVC) versus octaspline catheter + unipolar in the IVC versus octaspline catheter + unipolar embedded in the mapping catheter. Acute procedural and midterm endpoints were assessed. Results: The use of an octaspline catheter increased the number of total LAT points (1010 ± 451 vs. 397 ± 213, p = 0.001), LAT points near the successful RF ablation site (118 ± 105 vs. 21 ± 19, p = 0.010) and electrograms (EGM) per PVC (23 ± 21 vs. 7 ± 3, p = 0.032), while reducing mapping duration (65 ± 41 EGM/min vs. 21 ± 8 EGM/min, p = 0.003). However, signal resolution was not superior to that obtained with the pentaspline catheter, with similar bipolar ( p = 0.505) and unipolar ( p = 0.176) voltages, an increased bipolar signal duration ( p = 0.003) and a reduction in the unipolar signal duration ( p = 0.013). Use of a catheter‐embedded unipolar reference led to shorter unipolar signal duration (76 ± 34 ms vs. 142 ± 29 ms, p < 0.001), and provided an earlier unipolar signal deflection to QRS onset (−24 ± 16 ms vs. −19 ± 11 ms, p = 0.006) and earlier −dV/dT signal annotation (−12 ± 10 ms vs. −7 ± 9 ms, p < 0.001). This subsequently led to a shorter distance from the earliest LAT to successful RF site ( p = 0.014). No significant differences between multielectrode mapping catheters were seen regarding catheter‐induced ectopy rate ( p = 0.703). Conclusions: The use of an octaspline catheter combined with an embedded unipolar reference may associate with faster, more detailed and accurate activation mapping in the setting of PVC ablation.

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