A Comparison of Unipolar and Bipolar Electrodes During Cardiac Mapping Studies

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Abstract
Controversy exists as to whether the unipolar or bipolar electrode configuration is superior in detecting local activations during cardiac mapping studies. However, the strengths and weaknesses of each mode suggest that they may provide complementary information. To examine the relative merits of unipolar and bipolar electrode configurations, recordings by each were simultaneously acquired during episodes of ventricular tachycardia in eight consecutive patients undergoing map guided arrhythmia surgery. Unipolar electrograms were classified as either unambiguous or ambiguous according to whether or not they were polyphasic in nature. The activation times from the unambiguous electrograms were compared with activation times from the corresponding bipolar signals where local activation was measured both at the signal's peak amplitude (BI-PK), and at the point at which the waveform's first major, rapid transient crossed baseline (BI-TRN). Occurrences of discrete diastolic activations were also quantified from the unipolar and bipolar tracings. From a total of 415 unipolar electrograms, 301 unambiguous signals were identified as suitable for comparison with the bipolar signals. Both BI-PK and BI-TRN criteria for the determination of local activation were highly correlated with and not significantly different from the local activation from the unipolar electrogram. From 85 ambiguous unipolar electrograms, it was possible to determine local activation from the corresponding bipolar signal in 33% of the occurrences. From the eight patients, 64 diastolic potentials were recorded of which 42 were seen only in bipolar mode, 7 in only unipolar mode, and 15 were evident in both tracings. The prevalence of diastolic potentials was significantly greater in recordings made using bipolar mode. The results demonstrate that complementary information regarding local activations and diastolic potentials can be derived from unipolar and bipolar recordings and suggest that both electrode configurations should be used in multichannel cardiac mapping systems.