Traditional Electrophysiological Mapping

  • Tushar V. Salukhe
  • Louisa Malcolme-Lawes
  • Pipin Kojodjojo
  • Nicholas S. Peters


Technological advances over the last two decades have assisted the electrophysiologist in identifying tachycardia mechanisms and guiding ablation therapy. However, accurate analysis and interpretation of the surface electrocardiogram (ECG) and intracardiac signals remain fundamental to conventional mapping. This chapter details the three maneuvers most commonly employed, usually in combination, including activation sequence mapping, pace mapping, and entrainment. These techniques are essential in any standard electrophysiological study and apply to both focal and reentrant forms of tachycardia. Critical to the effective use of these maneuvers is a clear appreciation of the mechanism of tachycardia which is briefly outlined in this chapter.


Atrial Tachycardia Accessory Pathway Reentrant Tachycardia Reentry Circuit Reentry Tachycardia 
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  1. 1.
    Wen MS, Yeh SJ, Wang CC, et al. Successful radiofrequency ablation of idiopathic left ventricular tachycardia at a site away from the tachycardia exit. J Am Coll Cardiol 1997; 30:1024–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Stevenson WG, Weiss JN, Wiener I, et al. Fractionated endocardial electrograms are associated with slow conduction in humans: evidence from pace-mapping. J Am Coll Cardiol 1989; 13:369–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Cassidy DM, Vassallo JA, Miller JM, et al. Endocardial catheter mapping in patients in sinus rhythm: relationship to underlying heart disease and ventricular arrhythmias. Circulation 1986; 73:645–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Man KC, Daoud EG, Knight BP, et al. Accuracy of the unipolar electrogram for identification of the site of origin of ventricular activation. J Cardiovasc Electrophysiol 1997; 8:974–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Cassidy DM, Vassallo JA, Buxton AE, et al. The value of catheter mapping during sinus rhythm to localize site of origin of ventricular tachycardia. Circulation 1984; 69:1103–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Schilling RJ, Peters NS, Davies DW. Simultaneous endocardial mapping in the human left ventricle using a noncontact catheter: comparison of contact and reconstructed electrograms during sinus rhythm. Circulation 1998; 98:887–98.PubMedCrossRefGoogle Scholar
  7. 7.
    Marchlinski FE, Callans DJ, Gottlieb CD, et al. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation 2000; 101:1288–96.PubMedCrossRefGoogle Scholar
  8. 8.
    Goyal R, Harvey M, Daoud EG, et al. Effect of coupling interval and pacing cycle length on morphology of paced ventricular complexes. Implications for pace mapping. Circulation 1996; 94:2843–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Klein LS, Shih HT, Hackett FK, et al. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation 1992; 85:1666–74.PubMedCrossRefGoogle Scholar
  10. 10.
    Calkins H, Kalbfleisch SJ, el-Atassi R, et al. Relation between efficacy of radiofrequency catheter ablation and site of origin of idiopathic ventricular tachycardia. Am J Cardiol 1993; 71:827–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Kadish AH, Childs K, Schmaltz S, Differences in QRS configuration during unipolar pacing from adjacent sites: implications for the spatial resolution of pace-mapping. J Am Coll Cardiol 1991; 17:143–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Brunckhorst CB, Stevenson WG, Soejima K, et al. Relationship of slow conduction detected by pace-mapping to ventricular tachycardia re-entry circuit sites after infarction. J Am Coll Cardiol 2003; 41:802–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Stevenson WG, Khan H, Sager P, et al. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation 1993; 88:1647–70.PubMedCrossRefGoogle Scholar
  14. 14.
    Waldo AL. Atrial flutter: entrainment characteristics. J Cardiovasc Electrophysiol 1997; 8:337–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Waldo AL, Henthorn RW. Use of transient entrainment during ventricular tachycardia to localize a critical area in the reentry circuit for ablation. Pacing Clin Electrophysiol 1989; 12:231–44.PubMedCrossRefGoogle Scholar
  16. 16.
    Henthorn RW, Okumura K, Olshansky B, et al. A fourth criterion for transient entrainment: the electrogram equivalent of progressive fusion. Circulation 1988; 77:1003–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Knight BP, Ebinger M, Oral H, et al. Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia. J Am Coll Cardiol 2000; 36:574–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Michaud GF, Tada H, Chough S, et al. Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing. J Am Coll Cardiol 2001; 38:1163–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Miller JM, Rosenthal ME, Gottlieb CD, et al. Usefulness of the delta HA interval to accurately distinguish atrioventricular nodal reentry from orthodromic septal bypass tract tachycardias. Am J Cardiol 1991; 68:1037–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Hirao K, Otomo K, Wang X, et al. Para-Hisian pacing. A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation 1996; 94:1027–35.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Tushar V. Salukhe
    • 1
  • Louisa Malcolme-Lawes
  • Pipin Kojodjojo
  • Nicholas S. Peters
  1. 1.Department of CardiologySt. Mary’s Hospital and Imperial College Healthcare NHS TrustLondonUK

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