Endocardial Catheter Pace Mapping of Ventricular Tachycardias

Mithilesh K. Das, John C. Lopshire, Deepak Bhakta, Anil V. Yadav, John M. Miller

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Several mapping techniques are used during catheter ablation of ventricular tachycardia (VT), including activation mapping, pace mapping, entrainment mapping, and substrate mapping. These mapping techniques complement one another, and all of these tools can be used to localize the critical isthmus of a hemodynamically stable sustained reentrant monomorphic VT, whereas activation mapping and pace mapping are the only useful techniques available for localizing the exit sites of a focal VT or frequent symptomatic premature ventricular complexes (PVCs). Pace mapping is performed to replicate 12-lead ECG configuration of a spontaneous or induced VT. If the pace map from the isthmus site of a reentrant VT has a long S-QRS that is similar to the electrogram (Egm) during VT, and yields complete replication of each feature of each ECG lead, it signifies that the catheter is located on the critical isthmus, which is an expected site of successful ablation. Activation and pace mapping of a Purkinje-like potential prior to a PVC that initiates polymorphic VT and ventricular fibrillation is helpful in determining the successful site of ablation of these arrhythmias. Pace mapping is especially useful when VT is hemodynamically unstable because both activation and entrainment mapping require that the VT should be easily inducible, sustained, and hemodynamically stable so that sampling of Egm timing from multiple sites and repeated pacing maneuvers can be performed.

Original languageEnglish (US)
Title of host publicationCardiac Mapping, Third Edition
PublisherWiley-Blackwell
Pages366-375
Number of pages10
ISBN (Print)9781405175722
DOIs
StatePublished - Feb 26 2009

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Keywords

  • Endocardial catheter pace mapping of VT
  • Pace mapping - useful in mapping
  • Pace mapping for focal MMVT or isolated PVCs/couplets/bigeminy
  • Pace mapping for macroreentrant VT
  • Pace mapping for polymorphic VT and VF
  • Pace mapping for VT

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Das, M. K., Lopshire, J. C., Bhakta, D., Yadav, A. V., & Miller, J. M. (2009). Endocardial Catheter Pace Mapping of Ventricular Tachycardias. In Cardiac Mapping, Third Edition (pp. 366-375). Wiley-Blackwell. https://doi.org/10.1002/9781444303438.ch29