[Electroanatomical mapping systems in catheter ablation of cardiac arrhythmias]

Abstract

Due to the recent technical development of the past years, most cardiac electrophysiological laboratories are equipped with computer-based electroanatomical mapping systems that precisely describe both the temporal and spatial characteristics of cardiac activation. This development has also been driven by the need for increased accuracy in arrhythmia localization as required for catheter ablation. Computer-based electroanatomical mapping systems are able to reconstruct cardiac anatomy and provide a straightforward representation of chamber activation. These systems capture and display details of intracardiac physiology and mark the site of interventions. Nowadays, several mapping technologies are available in the electrophysiological labs: CARTO XP, EnSite NavX and Array, Real-time Position Management. In this paper we aim to briefly present the principal technological and practical characteristics of these mapping systems regarding eligibility, ability and limitations. The development of computer-based mapping technologies is also discussed in detail, since future systems will be able to display any parametric process including vectors, strains, contraction patterns etc., a wide variety of physiologic parameters beyond activation times and voltage. Using electroanatomical mapping systems, the specific recording of both anatomy and physiology has contributed substantially to the expansion of ablation to atypical atrial flutters, ventricular tachycardia, congenital heart-disease-related arrhythmias and atrial fibrillation. While the technology is already facilitating, the obvious down-side to this technological explosion is cost. Subsequent studies will be needed, however, to show that this translates into improved outcomes and cost savings.