Roles and Responsibilities
- Take ownership and participate actively in the mapping process
- Sit at the console if possible
- Make sure you can review the signals
Signals > Colours
Hardware
Multi electrode catheter
Deflectable Sheath
Multi Electrode Mapping
High density mapping
- More detailed maps
- Shorter time to create map
- Verification / re-annotation difficult or impossible
- Not totally equivalent to point by point mapping
Automatic mapping - High density without MEM
Including entrainment
Imaging
- CT merge
- ICE - With or without integration
Deciding on chamber to map
Approach to catheter ablation of left atrial �utters Steven M. Markowitz MD, George Thomas MD, Christopher F. Liu MD, Jim W. Cheung MD, James E. Ip MD, Bruce B. Lerman MD. JCE 2019
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Miyazaki H, Stevenson WG, Stephenson K, Soejima K, Epstein LM. Entrainment mapping for rapid distinction of left and right atrial tachycardias. Heart Rhythm. 2006 May;3(5):516-23. doi: 10.1016/j.hrthm.2006.01.014. Epub 2006 Feb 28. PMID: 16648054.
Setting the window of interest
Seeing the P wave
Choosing a reference
Timing Reference
P wave in relation to reference
P wave in relation to reference
Window onset
De Ponti method
De Ponti R, Verlato R, Bertaglia E, Del Greco M, Fusco A, Bottoni N, Drago F, Sciarra L, Ometto R, Mantovan R, Salerno-Uriarte JA. Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus. Europace. 2007 Jul;9(7):449-57. doi: 10.1093/europace/eum055. Epub 2007 May 3. PMID: 17478460.
No clear isoelectric segment
Long P wave duration in relation to CL
Selvaraj RJ et al. Chasing red herrings: making sense of the colors while mapping. Circ Arrhythm Electrophysiol. 2014 Jun;7(3):553-6.
Selvaraj RJ et al. Chasing red herrings: making sense of the colors while mapping. Circ Arrhythm Electrophysiol. 2014 Jun;7(3):553-6.
P end to P end
Mechulan A, Bun SS, Masse A, Peret A, Leong-Feng L, Pons F, Bouharaoua A, Dieuzaide P, Prévot S. An improved window of interest for electroanatomical mapping of atrial tachycardia. J Interv Card Electrophysiol. 2022 Jan;63(1):29-37. doi: 10.1007/s10840-021-00940-0. Epub 2021 Jan 27. PMID: 33506319; PMCID: PMC8755667.
Window length
- 80% of CL
- 90% of CL
- 100% of CL
Why not 100% ?
Advanced visualization aids
LAT histogram
Use of the LAT histogram “trough” to identify the slow conduction channel in complex congenital heart disease macro re-entrant arrhythmias. Nathan Denham, Andrew Ha, Raja Selvaraj, Krishnakumar Nair. CJC Pediatric and Congenital Heart Disease 2024
Ripple maps
Ripple maps
Luther V, Linton NW, Koa-Wing M, Lim PB, Jamil-Copley S, Qureshi N, Ng FS, Hayat S, Whinnett Z, Davies DW, Peters NS, Kanagaratnam P. A Prospective Study of Ripple Mapping in Atrial Tachycardias: A Novel Approach to Interpreting Activation in Low-Voltage Areas. Circ Arrhythm Electrophysiol. 2016 Jan;9(1):e003582. doi: 10.1161/CIRCEP.115.003582. PMID: 26757985.
Coherent mapping
Anter E, Duytschaever M, Shen C, Strisciuglio T, Leshem E, Contreras-Valdes FM, Waks JW, Zimetbaum PJ, Kumar K, Spector PS, Lee A, Gerstenfeld EP, Nakar E, Bar-Tal M, Buxton AE. Activation Mapping With Integration of Vector and Velocity Information Improves the Ability to Identify the Mechanism and Location of Complex Scar-Related Atrial Tachycardias. Circ Arrhythm Electrophysiol. 2018 Aug;11(8):e006536. doi: 10.1161/CIRCEP.118.006536. PMID: 30354312.
Summary
- Set up and mapping is not automatic
- Understand and participate in the process
- Basic concepts - series of articles in Circ Arrhythmia 2010-2011
- Constantly evolving set of tools