25. Three-Dimensional Post-Pacing Interval Mapping of Left Atrial Tachycardia

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Philipp Sommer and
  2. Christopher Piorkowski

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch25

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Sommer, P. and Piorkowski, C. (2013) Three-Dimensional Post-Pacing Interval Mapping of Left Atrial Tachycardia, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch25

Editor Information

  1. 2

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 3

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 4

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 5

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 6

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585



  • ablation of atrial fibrillation;
  • gap;
  • circumferential lesion;
  • secondary arrhythmia;
  • atypical atrial flutter;
  • reentrant circuit;
  • 3D mapping system;
  • activation map.


Left atrial tachycardias (LATs) most frequently occur as secondary arrhythmias following ablation procedures for atrial fibrillation. Understanding of the reentrant circuit is crucial for a successful ablation of these tachycardias. We describe a method to visualize the reentrant circuit which besides the “classical” mapping options as activation or voltage mapping allows to precisely identify the pathway in the left atrium.

In these post-pacing interval (PPI) maps the difference between the local return cycle and the tachycardia cycle length (TCL) is displayed color-coded using the LAT function of three-dimensional (3D) mapping systems. Stimulating from within the reentrant circuit this difference will be close to zero; the more distant the ablation catheter is stimulating from the greater this difference gets (e.g. 100 ms). After local stimulation of 20-30 distinguished points in the left atrium this PPI map will facilitate the understanding of the tachycardia's pathway and allow a successful ablation.