Non-fluoroscopic catheter-based mapping systems in cardiac electrophysiology—from approved clinical indications to novel research usage

Abstract

During 20 years of development of catheter-based technologies in the management of cardiac arrhythmias, electrophysiological mapping/ablation systems have evolved from single-plane fluoroscopic mapping to three-dimensional (3-D) non-fluoroscopic computer-based mapping systems. Based on magnetic technology, the electro-anatomic CARTO mapping system can accurately correlate local electrograms with recording sites, by which the system can reconstruct 3-D maps with colour-coded electrophysiological information superimposed on the anatomy. Whereas the CARTO system is primarily designed for studying cardiac activation and not repolarisation, the system has been widely used in the diagnosis and ablation of cardiac arrhythmias and in the research of basic arrhythmic mechanisms. In order to study cardiac repolarisation in vivo, an innovative method, the monophasic action potential (MAP) mapping technique, which integrates MAP recording with electroanatomical mapping, has recently been developed in our centre. Using the MAP technique, global sequence and dispersion of atrial/ventricular repolarisation have been evaluated in vivo in both experimental and clinical settings. The innovative MAP technique provides unique research opportunities for in vivo studies of basic electrophysiological mechanisms.