Matching Electrode Configuration to Signal Sensing for Cardiac Electroanatomic Mapping: A Critical Appraisal.

Abstract

The management of cardiac arrhythmias has been transformed by electroanatomical mapping, yet it is often underappreciated how dependent mapping is to electrode configuration, sensing modality, catheter geometry, and signal-processing characteristics. This review systematically evaluates how these features influence mapping, in the context of catheters in contemporary linear, circular, grid, star-shaped and basket configurations. We compare direct sensing strategies in unipolar and bipolar configurations, monophasic action potentials, and discuss post-processing approaches including omnipolar, multipolar, and Laplacian techniques. We gather evidence from computational, experimental and clinical studies to critically discuss how these considerations may influence signal acquisition and mapping resolution in the context of clinical mapping needs and, in particular, which may be most relevant for the complex arrhythmias of atrial fibrillation (AF) and ventricular tachycardia (VT). We conclude by pointing out future directions such as ultra-high-resolution mapping, adaptive catheter geometries, computational reconstruction, and AI-guided signal interpretation.