Endocardial Activation Mapping of Ventricular Tachycardia in Patients

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Abstract
Background—Localization of early activated endocardial areas during ventricular tachycardia (VT) is mandatory for performance of surgical or radiofrequency catheter interventions. The use of a multielectrode catheter may shorten the procedure time and increase the accuracy of the procedure compared with single-electrode mapping techniques. This study was performed to evaluate the safety and efficacy of a 32-bipolar-electrode mapping catheter in patients. Methods and Results—The basket-shaped mapping catheter (BMC), integrated with a computerized mapping system, allowed on-line reconstruction of endocardial activation maps. Twenty patients with VT were studied before surgery (n=4) or radiofrequency catheter ablation (n=16). End-diastolic left ventricular (LV) volume was 280±120 mL, with an LV ejection fraction of 33±14%. The volume encompassed by the BMC was 164±27 mL (130 to 200 mL); the deployment time was 46±11 minutes. Endocardial activation time during sinus rhythm was 105±34 ms; 14±5 electrodes could be used to stimulate the heart. Cycle length of VT was 325±83 ms. Earliest endocardial activation was recorded 58±42 ms before the onset of the surface ECG. Complications were pericardial effusion (n=2) and transient cerebral disorientation (n=1). Conclusions—Percutaneous multielectrode endocardial mapping in patients with VT is feasible and relatively safe. The use of this technique shortens the time patients have to endure VT.

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