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J Thorac Cardiovasc Surg 2001;121:0197-0199
© 2001 The American Association for Thoracic Surgery

Editorials

Return cycle mapping: Have we come full cycle?

From the Division of Cardiovascular Surgery, Department of Surgery, Division of Cardiology, Department of Medicine, and Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Ind.

Received for publication Sept 15, 2000. Accepted for publication Oct 13, 2000. Address for reprints: Yousuf Mahomed, MD, Division of Cardiovascular Surgery, Indiana University School of Medicine, 215 Emerson Hall, 545 N Barnhill Dr, Indianapolis, IN 46202.

See related article, p. 249.

Ventricular tachycardia (VT) occurring in patients who have had a previous myocardial infarction has been demonstrated to be due to reentry. Critical components of this reentrant circuit—without which the tachycardia cannot continue—have been shown to be located within endocardial or subendocardial layers of the infarct zone or its periphery. This is fortunate, in that it allows a surgeon's knife or an electrophysiologist's catheter to have access to critical components of the VT circuit to incise, remove, or ablate this relatively small amount of tissue and thereby eliminate VT recurrences. In hearts that have already sustained muscle loss from infarction, it stands to reason that one should attempt to minimize the amount of additional damage done to eradicate the tissue responsible for VT. The process of electrophysiologic mapping has been a mainstay of surgical therapy for VT in that it attempts to localize these critical areas of the reentrant circuit, such that minimal incision, resection, or ablation could effect antiarrhythmic success. The more complete the mapping data, the better the arrhythmia cure rate. ¹ However, in practice, mapping has several limitations (some of which are discussed herein), and because one cannot always be certain that all arrhythmogenic areas have been identified, most surgeons use a generous resection or cryoablation margin beyond areas indicated by mapping—even to the point of removing all visible endocardial scar. ²

Standard VT mapping and return cycle mapping

During standard VT mapping, one attempts to locate areas of the endocardium from which diastolic potentials (timing between the end of one VT QRS and the next) are recorded. The central common pathway (CCP) of the VT circuit should be in such an area, although diseased tissue in . . . [Full Text of this Article]

Related Article

Cryoablation of ventricular tachycardia guided by return cycle mapping after entrainment

Takashi Nitta, Masataka Mitsuno, Chris K. Rokkas, Richard Lee, Richard B. Schuessler, and John P. Boineau
J. Thorac. Cardiovasc. Surg. 2001 121: 249-258. [Abstract] [Full Text] [PDF]