Adv EP Lesson 8: Mapping Basics

what is this and purpose

activation map

helps visualize a rhythm with additional tools like propagation animation and can show areas of slow conduction or block

what is this and purpose

voltage map

displays tissue voltage as a color and is determined by physician preference

helps visualize tissue health based on relative voltage values

can show areas of scar or isolcation/block; useful for checking PVI

trigger signal

tells the system when a new beat occurs

IVC anatomy

inferior portion of the venous return that connects to the RA

where the IVC meets the floor of the RA is the

Eustachian ridge

AV node anatomy

sits superior to the CS ostium on the near the septal leaflet of the TV

SVC anatomy

superior portion to the venous return that connects the RA

what makes the group of cells that makes the SA node

lateral portion of the SVC/RA junction contains this group of cells

what sits close the the RSPV

septal side of the SVC

CS anatomy right regions and left regions

right: located low on the septum of the RA near the TV

left: epicardial to the LA running from the inferior side, up the lateral wall by the appendage, and anterior

the right phrenic nerve is close to what

RSPV

coumadin ridge anatomy

sits bw the left PVs and the LAA

what is the most anterior sturcture of the heart

RVOT

blood flow with RVOT

blood flows from the RV to the lungs through the pulmonary valve and Pulmonic artery

what are more commonly found in RVOT vs LVOT

outflow tract PVCs

LVOT place

posterior to the RVOT leading tot he aorta and the rest of the arterial system

focal rhtyhms

Atrial tachycardia

PVC/non ischemic VT

how do we map atrial tachycardia

goal: find the earliest atrial activation

ideal ablation target: completely negative unipolar signal

treating AT

once earliest site is located, it is surrounded by points with a later activation time

post-ablation response: ectopy matching the tachycardia or acceleration, termination of tachycardia, inability to induce tachycardia

PVC/Ischemic VT mapping

comparing the 12lead ECG tot he clinical PVC can confirm early activation is a good target for ablation

PVC/Ischemic VT treatment

focal RF ablation

reentry arrythmias

typical Atrial flutter, atypical atrial flutter, AVNRT, AVRT, ischemic ventricular tachycardia

treatment for typical atrial flutter

CTI ablation

treatment for atypical atrial flutter

linear ablation anchored to sites of previous ablation, scar, etc

in a safe anatomical location

as short as possible

how do we map AVNRT

once confirmed it’s AVNRT, typically treated as an anatomical ablation and rarely mapped

two primary methods of mapping AVNRT

wavefront collision during sinus rhtyhm

low voltage bridge mapping during sinus rhythm

both to visualize near the slow pathway

treatment of AVNRT

ablation of slow pathway

treatment for AVRT

ablate the pathway closest tot he AV timing

treatment for AF

PVI via RF/PF or cryo