Expanding Applications of Three-Dimensional Cardiac Mapping Systems: A Review

Percutaneous coronary intervention (PCI) is a widely performed revascularisation procedure for coronary artery disease. Although effective, its reliance on fluoroscopy and iodinated contrast exposes patients and operators to risks of radiation and nephrotoxicity. As PCI techniques have become more complex, interest has grown in imaging methods that reduce dependence on fluoroscopy and contrast. Electro-anatomical mapping systems (EAMS), developed for catheter navigation in electrophysiology, enable real-time three-dimensional visualisation without the need for fluoroscopy or contrast. By adapting coronary guidewires as electrodes, EAMS can reconstruct vessel anatomy and track interventional tools in real time. EAMS have demonstrated feasibility and safety in device implantation, and early studies suggest their applicability to PCI, where they may mitigate radiation and contrast exposure by providing an alternative method for guidewire and stent visualisation. This review provides a narrative overview of current evidence, outlining the technical principles, applications in device implantation, and the emerging role of EAMS in coronary intervention.