Three-Dimensional Mapping in Interventional Electrophysiology: Techniques and Technology

Douglas L. Packer, M.D.

J Cardiovasc Electrophysiol. 2005;16(10):1110-1116.

Introduction

Since the introduction of single catheter His bundle recordings nearly four decades ago, substantial inroads into the elucidation of the mechanisms of cardiac arrhythmias have been made. Single-channel evaluations have given way to simultaneous, multichannel mapping, resulting in more detailed temporal characterization of specific arrhythmias. It has thereby become increasingly difficult to keep track of an ever increasing number of channels of electrograms and analyze them within the context of their specific anatomic origins. This limitation has provided the incentive for the development of computer-based mapping that chronicles both the temporal and spatial characteristics of cardiac activation. This development has also been driven by the need for increasing accuracy in arrhythmia localization as required for catheter ablation.^[1]

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Comparison of Three-Dimensional Mapping Systems
Feature/Mapping System	Carto	EnSite	NavX	RPM	LocaLisa*
Replicates anatomy without distortion	+++	++	++	++	–
Multiple chamber/structure rendering (simultaneous)	+++	–	++	–	–
Pulmonary vein, SVC/IVC display	Rendered anatomy or pulled tubes	Cut outs/juxtaposed spheres	Cut outs/juxtaposed spheres	–	–
Esophagus annotation	No	Direct localization	Direct localization	–	+
Interstructure delineation without interpolation obliteration	++	Fixed points required	Fixed points required	Snap points required	No surface geometry
Spatial accuracy (mm)	1	<1	<1	2	2
Temporal accuracy (sampling rate)	0.1 K	1.2 K	1.2 K	3 K
Simultaneous onscreen map view windows	2	2	2	2	2
Virtual cardioscope views	+++	+++	+++	+	–
Ease of map display user interface	+++	++	++	++	+
"Transparency" view	No	Yes	Yes	Yes	–
Activation time mapping	+++	++	++	+++	Annotation by hand
Voltage mapping	+++	++++	+++	+	Annotation by hand
High-resolution electrogram mapping	+	+++	+	+	No
Nonsustained AT/VT-APC/VPC mapping	With effort	++++	With effort	With effort	–
Unstable AT/VT mapping	No	+++	No	No	No
Robust intervention annotation (ablation dots)	++++	+++	+++	++	++
Detection of low-amplitude signals	++	++	++	+++	+
Repolarization mapping	+	+++	No	+	–
Mapping using alternative signal content	In development	In development	In development	In development	No
Mechanical/contraction mapping	Yes NOGA	No	No	No	No
Preablation map-based intervention planning	+++	+	+	+	No
Click and point electrogram recall	+++	+++	++	+++	No
Catheter tip/tissue contact visualization	+++	++	+	+	++
Multiple chamber mapping (synchronized)	+++	–	++	–	–
Geometry "learning" during mapping and ablation	+++	+	+	–	–
Ablation catheter use	Specific	Any	Any	Specific	Any
Navigation/electrograms during ablation	Yes	Yes	Yes	No	Yes
Respiratory compensation	+	+++	+++	–	No
Simultaneous electrode recordings	26	Array +4	64	N/A	?

*Catheter localization system.
AT = atrial tachycardia; SVC = superior vena cava; IVC = inferior vena cava.

Comparison of Three-Dimensional Mapping Systems
Feature/Mapping System	Carto	EnSite	NavX	RPM	LocaLisa*
Replicates anatomy without distortion	+++	++	++	++	–
Multiple chamber/structure rendering (simultaneous)	+++	–	++	–	–
Pulmonary vein, SVC/IVC display	Rendered anatomy or pulled tubes	Cut outs/juxtaposed spheres	Cut outs/juxtaposed spheres	–	–
Esophagus annotation	No	Direct localization	Direct localization	–	+
Interstructure delineation without interpolation obliteration	++	Fixed points required	Fixed points required	Snap points required	No surface geometry
Spatial accuracy (mm)	1	<1	<1	2	2
Temporal accuracy (sampling rate)	0.1 K	1.2 K	1.2 K	3 K
Simultaneous onscreen map view windows	2	2	2	2	2
Virtual cardioscope views	+++	+++	+++	+	–
Ease of map display user interface	+++	++	++	++	+
"Transparency" view	No	Yes	Yes	Yes	–
Activation time mapping	+++	++	++	+++	Annotation by hand
Voltage mapping	+++	++++	+++	+	Annotation by hand
High-resolution electrogram mapping	+	+++	+	+	No
Nonsustained AT/VT-APC/VPC mapping	With effort	++++	With effort	With effort	–
Unstable AT/VT mapping	No	+++	No	No	No
Robust intervention annotation (ablation dots)	++++	+++	+++	++	++
Detection of low-amplitude signals	++	++	++	+++	+
Repolarization mapping	+	+++	No	+	–
Mapping using alternative signal content	In development	In development	In development	In development	No
Mechanical/contraction mapping	Yes NOGA	No	No	No	No
Preablation map-based intervention planning	+++	+	+	+	No
Click and point electrogram recall	+++	+++	++	+++	No
Catheter tip/tissue contact visualization	+++	++	+	+	++
Multiple chamber mapping (synchronized)	+++	–	++	–	–
Geometry "learning" during mapping and ablation	+++	+	+	–	–
Ablation catheter use	Specific	Any	Any	Specific	Any
Navigation/electrograms during ablation	Yes	Yes	Yes	No	Yes
Respiratory compensation	+	+++	+++	–	No
Simultaneous electrode recordings	26	Array +4	64	N/A	?

*Catheter localization system.
AT = atrial tachycardia; SVC = superior vena cava; IVC = inferior vena cava.

Comparison of Three-Dimensional Mapping Systems
Feature/Mapping System	Carto	EnSite	NavX	RPM	LocaLisa*
Replicates anatomy without distortion	+++	++	++	++	–
Multiple chamber/structure rendering (simultaneous)	+++	–	++	–	–
Pulmonary vein, SVC/IVC display	Rendered anatomy or pulled tubes	Cut outs/juxtaposed spheres	Cut outs/juxtaposed spheres	–	–
Esophagus annotation	No	Direct localization	Direct localization	–	+
Interstructure delineation without interpolation obliteration	++	Fixed points required	Fixed points required	Snap points required	No surface geometry
Spatial accuracy (mm)	1	<1	<1	2	2
Temporal accuracy (sampling rate)	0.1 K	1.2 K	1.2 K	3 K
Simultaneous onscreen map view windows	2	2	2	2	2
Virtual cardioscope views	+++	+++	+++	+	–
Ease of map display user interface	+++	++	++	++	+
"Transparency" view	No	Yes	Yes	Yes	–
Activation time mapping	+++	++	++	+++	Annotation by hand
Voltage mapping	+++	++++	+++	+	Annotation by hand
High-resolution electrogram mapping	+	+++	+	+	No
Nonsustained AT/VT-APC/VPC mapping	With effort	++++	With effort	With effort	–
Unstable AT/VT mapping	No	+++	No	No	No
Robust intervention annotation (ablation dots)	++++	+++	+++	++	++
Detection of low-amplitude signals	++	++	++	+++	+
Repolarization mapping	+	+++	No	+	–
Mapping using alternative signal content	In development	In development	In development	In development	No
Mechanical/contraction mapping	Yes NOGA	No	No	No	No
Preablation map-based intervention planning	+++	+	+	+	No
Click and point electrogram recall	+++	+++	++	+++	No
Catheter tip/tissue contact visualization	+++	++	+	+	++
Multiple chamber mapping (synchronized)	+++	–	++	–	–
Geometry "learning" during mapping and ablation	+++	+	+	–	–
Ablation catheter use	Specific	Any	Any	Specific	Any
Navigation/electrograms during ablation	Yes	Yes	Yes	No	Yes
Respiratory compensation	+	+++	+++	–	No
Simultaneous electrode recordings	26	Array +4	64	N/A	?

*Catheter localization system.
AT = atrial tachycardia; SVC = superior vena cava; IVC = inferior vena cava.

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