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Non-contact mapping in cardiac electrophysiology

  • Marcus Wieczorek
Schwerpunkt
  • 17 Downloads

Abstract

Catheter ablation of atrial and ventricular arrhythmias is now considered a standard technology for selected patients. In some patients, however, cure of the arrhythmia is hampered by the complexity of the arrhythmia or the way the arrhythmia presents in the electrophysiological laboratory: some focal atrial and ventricular arrhythmias are difficult to induce using electrical stimulation or medical provocation. Precise mapping of these arrhythmias is challenging or even impossible by contact mapping, while other arrhythmias are poorly tolerated and need early termination.

In these scenarios, use of non-contact mapping technology can be an alternative to conventional mapping, since isopotential maps may require no more than one ectopic beat identical with the clinical focal arrhythmia to reconstruct its endocardial origin. This review article presents the technology of non-contact cardiac mapping, as well as various arrhythmias that have been successfully treated using this technology in the past. The possibilities and limitations of using non-contact cardiac mapping under various conditions are also presented.

Keywords

Electrical stimulation Tachycardias Catheter ablation Unipolar electrograms Isopotential maps 

„Non-contact mapping“ in der kardialen Elektrophysiologie

Zusammenfassung

Die Katheterablation atrialer und ventrikulärer Herzrhythmusstörungen ist mittlerweile ein Standardverfahren für ausgewählte Patienten. In einigen Fällen jedoch gestaltet sich die Ablationsbehandlung der Arrhythmie als schwierig, da ihr ein komplexes Substrat zugrunde liegt oder die Arrhythmie selbst nur unzureichend durch elektrische Stimulation bzw. medikamentöse Provokation induziert werden kann. Hierdurch wird ein präzises, konventionelles „contact mapping“ entweder sehr erschwert oder gar unmöglich. In anderen Fällen muss die induzierte Arrhythmie schnell terminiert werden, da sie rasch zu einer hämodynamischen Instabilität führt. Insbesondere in solchen Situationen kann der Einsatz eines Non-contact-mapping-Systems zielführend sein, da im Idealfall nach Erstellung einer „isopotential map“ ein singulärer Schlag der klinischen fokalen Arrhythmie deren endokardialen Ursprung erkennen lässt. In der vorliegenden Übersicht soll die Technik des kardialen „non-contact mapping“ beschrieben werden. Zudem werden die relevanten klinischen Arrhythmien, die bisher unter Einsatz eines Non-contact-mapping-Systems erfolgreich behandelt werden konnten, dargestellt. Möglichkeiten und Limitationen, die sich aus den spezifischen Situationen ergeben, wurden hierbei berücksichtigt.

Schlüsselwörter

Elektrische Stimulation Tachykardien Katheterablation Unipolare Elektrogramme „Isopotential maps“ 

Notes

Compliance with ethical guidelines

Conflict of interest

M. Wieczorek has received honoraria for lectures from Abbott and St. Jude Medical.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiology and Electrophysiology, St. Agnes-Hospital BocholtWitten/Herdecke University, School of MedicineBocholtGermany

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