Techniques for Intraoperative Mapping of Tachyarrhythmias in Preexcitation Syndromes
Advances in both cardiac surgery and the technology of recording and displaying electrical signals from biologic tissues have contributed to the evolution of intraoperative electrophysiologic evaluation in patients with preexcitation syndromes. As early as 1930, Barker  demonstrated the feasibility of epicardial electrogram recordings in the human heart and reported activation times at ventricular epicardial sites in a patient with a chronically open chest wound (Figure 25-1). In 1967, Durrer and Roos  obtained activation times determined from unipolar ventricular electrograms and demonstrated very early excitation at the lateral aspect of the base of the right ventricle in a patient with atrial septal defect and Wolff-Parkinson-White (WPW) syndrome. In that same year Burchell et al.  utilized ventricular activation times to evaluate ventricular excitation during sinus rhythm, and atrial activation times to evaluate atrial excitation during tachycardia in a patient with atrial septal defect and WPW syndrome. Even though the attempt to interrupt the accessory connection in this patient was unsuccessful, demonstration of the proximity of the site of early ventricular activation during prexcitation to the early site of atrial activation during tachycardia was important in establishing and defining the role of intraoperative electrophysiologic recordings in localizing the site of surgical exploration or accessory connetion ablation (Figure 25-2). In 1968, a report from Duke University described the successful surgical ablation of an accessory connection ; the localization of the accessory connection was determined from the ventricular epicardial excitation sequence (isochrone map).
KeywordsElectrode Pair Delta Wave Graphic Tablet Bipolar Electrogram Pace Electrode
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