Electroanatomic Contact Mapping: How to Use Optimally to Recognise the Arrhythmia Mechanism?

The evolution in 3-D electroanatomic contact mapping systems has helped to considerably enhance the electrophysiologists’ understanding of real-time position management and mapping, thus to enable more precise catheter navigation within heart. These 3-D contact mapping techniques help to define the patient's cardiac anatomy in a better way for successful electrophysiological procedures by taking into account the importance of anatomic structures to the initiation and maintenance of cardiac arrhythmias. A system which plots the position of and activation time at a roving mapping catheter assists in identifying the sites of early activation for focal arrhythmias, and, combined with entrainment mapping, appears to be useful in identifying critical isthmuses in complex reentry circuits. 3D constructs of electrogram voltage may also help define areas of electrical scarring and infarction. Plotted together, these voltage, local activation timing and complex fractionated maps help to demonstrate the complex relation between the anatomical and functional barriers in the genesis of arrhythmias.