Advisor HD grid x vs. HD grid: a comparative study of mapping performance and procedural impact in an italian multicenter retrospective analysis
F Guarracini, L F Milillo, A Preda, M Del Greco, M Maines, F Peruzza, S Themistoclakis, P China, L Quinto, R Falcetti, F R Spera, L Bertagnolli, M Manfrin, F Torri, P MazzoneAbstract
Background
The Advisor™ HD Grid X catheter, recently introduced, features a closed-frame, four-spline design with electrodes in a grid pattern. Using omnipolar technology (OT), it acquires true local signals independent of orientation, improving mapping accuracy. Compared to the original HD Grid, HD Grid X integrates two magnetic sensors for advanced mapping with the EnSite™ X EP System.
Purpose
This study aimed to evaluate the initial clinical experience with the Advisor™ HD Grid X catheter across a range of cardiac arrhythmias and to compare its mapping efficiency with the standard Advisor™ HD Grid catheter.
Methods
In 116 patients across 6 Italian hospitals, 50 left atrium (LA) and 8 left ventricles (LV) maps were created with HD Grid X, and 50 LA and 8 LV maps with HD Grid. Data were retrospectively analyzed for safety, efficacy, and acute success (termination/non-inducibility of tachycardia, conduction block, or pulmonary vein isolation).
Results
The Advisor™ HD Grid X catheter demonstrated superior mapping efficiency compared to the standard HD Grid catheter. In the left atrium (LA), it significantly reduced mapping time (9.8 ± 3.79 minutes vs. 12 ± 4.7 minutes; p < 0.001), as shown in Figure 1A. A similar trend was observed in the left ventricle (LV), with shorter mapping times (34 ± 15 minutes vs. 47 ± 14 minutes; p = 0.101), although this difference did not reach statistical significance. Furthermore, the HD Grid X catheter yielded a significantly higher number of total acquired points in the LA (19,737 ± 10,042 vs. 13,489 ± 7,169; p < 0.001) and a greater point density (27 ± 8 vs. 15.9 ± 10.4 points/cm²; p < 0.001), as illustrated in Figures 1B and 1C. In the LV, the total number of acquired points was comparable between the two catheters (37,354 ± 2,512 vs. 35,950 ± 2,279; p = 0.914), while point density was significantly higher with the HD Grid X (52.5 ± 27 vs. 34.2 ± 13.2 points/cm²; p < 0.05). The enhanced spatial resolution of the HD Grid X catheter was particularly advantageous in anatomically complex regions and contributed to a reduction in fluoroscopy time in the LA (3.46 ± 2.36 vs. 4.34 ± 2.59 minutes; p = 0.228) and a significantly lower dose-area product (DAP) (7.24 ± 7 vs. 14.59 ± 11.58 Gy·cm²; p < 0.001). In the LV, fluoroscopy time was also reduced (6.08 ± 4.56 vs. 17 ± 8 minutes; p = 0.076), although this difference was not statistically significant.
Conclusion
HD Grid X improves mapping in LA and shows a trend toward greater efficiency in LV, supporting optimized ablation strategies and better clinical decision-making.