Mini-, Micro-, and Conventional Electrodes an in Vivo Electrophysiology and Ex Vivo Histology Head-to-Head Comparison

OBJECTIVES This study sought to assess the relative effect of catheter, tissue, and catheter-tissue parameters, on the ability to determine the amount of viable myocardium in vivo. BACKGROUND Although multiple variables impact bipolar voltages (BVs), electrode size, interelectrode spacing, and directional dependency are of particular interest with the development of catheters incorporating mini and microelectrodes. METHODS Nine swine with early reperfusion myocardial infarctions were mapped using the QDot catheter and then remapped using a Pentaray catheter. All QDot points were matched with Pentaray points within 5 mm. The swine were sacrificed, and mapping data projected onto the heart. Transmural biopsies corresponding to mapping points were obtained, allowing a comparison of electrograms recorded by mini, micro-, and conventional electrodes with histology. RESULTS The conventional BV of 2,322 QDot points was 1.9 +/- 1.3 mV. The largest of the 3 microelectrode BVs (BV mu Max) average 4.8 +/- 3.1 mV. The difference between the largest (BV mu Max) and smallest (BV mu Min) at a given location was 53.7 +/- 18.1%. The relationships between both BV mu Max and BV mu Min and between the conventional BV and BV mu Max were positively related but with a significant spread in data, which was more pronounced for the latter. Pentaray points positively related to the BV mu Max with poor fit. On histology, increasing viable myocardium increased voltage, but both the slope coefficient and fit were best for BV mu Max. CONCLUSIONS Using histology, we could demonstrate that BV mu Max is superior to identify viable myocardium compared with BVC and BV using the Pentaray catheter. The ability to simultaneously record 3 BV(mu)s with different orientations, for the same beat, with controllable contact and selecting BV mu Max for local BV may partially compensate for wave front direction. (C) 2021 by the American College of Cardiology Foundation.