Computerized potential distribution mapping: a new intraoperative mapping technique for ventricular tachycardia surgery.

Abstract

This study evaluated potential distribution mapping as a method for localizing the site of origin of ventricular tachycardia (VT). In contrast to conventional activation time maps, potential distribution maps require less editing and thus can be more automated and rapidly processed for interpretation of multiple beats of VT. As a series of potential distribution maps during VT is required for detailed analysis, an on-line computerized system was designed to display potential distribution maps sequentially at 1-ms intervals as a color movie. Potential distribution maps and activation time maps were constructed from 182 epicardial and endocardial unipolar electrodes during 12 episodes of reproducible monomorphic VT in 9 dogs four to six days after experimental myocardial infarction (mean cycle length, 162 +/- 21 ms). At the onset of each depolarization during VT, a potential minimum abruptly developed on the surviving epicardium and another on the surviving endocardium of the left ventricle, both immediately adjacent to the subendocardial infarct. These two minima on the initial potential distribution maps corresponded to the sites of earliest epicardial and endocardial activation breakthrough recorded on the activation time maps. These two minima subsequently expanded or moved into the adjacent area and coincided with the spread of activation fronts on the epicardial and endocardial surfaces. Thus, the rapid display of sequential, computerized potential distribution maps of multiple beats of VT provides a dynamic means of identifying the site of origin of VT, and therefore should facilitate intraoperative mapping.