Computer-assisted intraoperative mapping of the entire ventricular epicardium in the Wolff-Parkinson-White syndrome

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Intraoperative mapping of cardiac arrhythmias traditionally requires sustained rhythms, posing a challenge for patients with irregular heartbeats.
• Existing computerized mapping systems often focus on limited areas, potentially missing critical activation sites.

Purpose of the Study:

• To evaluate a novel computerized epicardial mapping system for rapid and comprehensive analysis of cardiac electrical activity in Wolff-Parkinson-White syndrome.
• To overcome the limitation of sustained rhythm requirement in traditional intraoperative mapping techniques.

Main Methods:

• A system utilizing a 60-electrode epicardial sock and a 56-electrode plaque for simultaneous, detailed mapping was employed in 16 patients.
• The technique involved sequential analysis of recordings from the sock and plaque to create complete isochronal epicardial maps.

Main Results:

• The system rapidly detected early activation at the atrioventricular (AV) groove, comparable to existing methods.
• Complete epicardial mapping provided crucial additional information, differentiating multiple accessory pathways and identifying ventricular epicardial breakthrough.
• The system facilitated the study of dynamic electrical events, including tachycardia initiation/termination and responses during atrial fibrillation.

Conclusions:

• This computerized mapping system offers a significant advancement for intraoperative assessment of Wolff-Parkinson-White syndrome.
• It provides rapid, detailed, and comprehensive epicardial mapping, enhancing diagnostic accuracy and understanding of complex arrhythmias.
• The technique is valuable for differentiating multiple accessory pathways and analyzing transient electrical phenomena.