Single catheter determination of local electrogram prematurity using simultaneous unipolar and bipolar recordings to replace the surface ECG as a timing reference

Bipolar recordings eliminate much of the far-field signal, while minimally filtered unipolar recordings contain substantial far-field signal component s. These properties may allow the onset of the unipolar recording to serve as a timing reference for the bipolar recording obtained from the same elec trode catheter during mapping of focal atrial or ventricular tachycardias. Mapping and RF ablation were performed in 26 patients with focal ventricula r tachycardia and 14 patients with focal atrial tachycardia. At 205 mapping sites, simultaneous recordings of (1) minimally filtered unipolar electrog rams (0.5-500 Hz), (2) high pass filtered unipolar electrograms (100 Hz), a nd (3) filtered bipolar recordings (30-500Hz) were analyzed. The interval b etween the onset of the minimally filtered unipolar electrogram and the fir st peak of the bipolar electrogram (Uni(On) - Bi-p) correlated closely with the timing of the local electrogram referenced to the surface ECG (r = 0.8 5, P < 0.001). Of 53 sites where RF ablation was performed, Uni(On) - Bi-p was shorter at successful compared to unsuccessful sites (3.8 +/- 3.5 vs 9. 2 +/- 5.2ms, P < 0.001) and was < 15 ms at all successful sites. In conclus ion, the comparison of simultaneous unipolar and bipolar electrograms from a single catheter allows assessment of the prematurity of local electrogram s from a focal source without the use of the P wave or QRS onset as a timin g reference.