Bipolar mapping, revisited or: These aren't the electrograms you're looking for

摘要

The substantial technological advancements over the past decade in the catheter ablation of ventricular arrhythmias (VA) have failed to produce a proportional improvement in procedural outcome. Particularly in patients with non-ischemic left ventricular cardiomyopathy (LVCM), the driving force for innovation has rightly focused upon enhanced characterization of arrhythmia substrate. The classical 2-dimensional model for reentrant ventricular tachycardia (VT) in which all of the critical circuit elements are located superficially within the subendocardium is a clear oversimplification when applied to the transmural circuits encountered in many LVCM patients. Historically, the identification of patients with complex substrate was often made in the wake of extensive and ineffective endocardial ablation.