Experience with Kapton-based bipolar electrode arrays used during computerized intraoperative mapping
Heart Valve Prosthesis Implantation
Magnetic Resonance Imaging, Cine
Mitral Valve Insufficiency
A new technology for intraoperative mapping of the sites of origin and propagation of supraventricular (SVT) and ventricular tachycardia (VT) was implemented and evaluated. Kapton forms a thin, flexible substrate on which copper layers can be bonded, etched, and interconnected similar to a multilayered printed circuit board. Narrow Kapton electrode assemblies with 20 contacts spaced over 113 mm were used to construct epicardial sock electrode arrays (Ep) having 238 electrodes and endocardial balloon electrode arrays (En) having 168 electrodes. These arrays were used for mapping 20 consecutive patients undergoing surgery for SVT or VT. In 10 surgeries for VT, bipolar electrograms from 1,045 Ep and 606 En electrode pairs were examined. Responses were recorded from 88.7% Ep and 94.9% En sites. Of 118 Ep sites not showing a response, 27.1% were due to poor electrode contact near the apex, or AV groove, and 70.3% approximated unexcitable tissue. Among the 31 En sites showing no response, 35.5% were located about the mitral annulus, and 32.3% over unexcitable tissue. In 10 surgeries for SVT, bipolar electrograms from 1,114 Ep electrode pairs were studied. Responses were seen at 94.3% sites. Of the 63 sites not showing a response, 63.5% resulted from poor electrode contact near the apex or AV groove. These electrode arrays, utilizing Kapton strips, have proven highly effective and reliable for computerized intraoperative recording.