Potential mapping in septal tachycardia. Evaluation of a new intraoperative mapping technique

A recently developed computer program is capable of rapidly (less than 5 minutes) constructing a series of potential-distribution maps (PDMs) for every msec of a 4-second window of ventricular tachycardia (VT). This study was performed to assess the ability of a series of PDMs to localize the site of earliest activation of VT originating in the interventricular septum. In 12 dogs, 13 morphologies of VT were initiated with programmed electrical stimulation 3-6 days after anterior septal coronary artery infarction. VT was mapped with endocardial and epicardial unipolar electrodes with a multipoint, computer-assisted mapping system. PDMs were compared with activation-time maps, and the former correctly identified the site of earliest activation of all 13 VT morphologies. When PDMs were viewed in sequence on a computer monitor, the site of earliest activation was signaled by abrupt development of a negative potential of less than -3.0 mV. The initial negative point subsequently expanded, and the spread of this negative-potential field correlated with activation sequence. PDMs provide an accurate, unambiguous, rapid means of analyzing large numbers of electrograms acquired with multipoint, computer-assisted mapping systems.