45. Combined Endocardial and Epicardial Mapping of Ventricular Tachycardia

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Mathew D. Hutchinson and
  2. Francis E. Marchlinski

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch45

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Hutchinson, M. D. and Marchlinski, F. E. (2013) Combined Endocardial and Epicardial Mapping of Ventricular 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.ch45

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. Cardiovascular Division, Department of Medicine; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

Publication History

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

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585



  • epicardial mapping;
  • radiofrequency ablation;
  • non-ischemic left ventricular cardiomyopathy;
  • arrhythmogenic right ventricular cardiomyopathy/dysplasia;
  • ischemic cardiomyopathy;
  • Chagas disease;
  • ventricular tachycardia;
  • unipolar electrograms;
  • electroanatomical mapping;
  • intracardiac echocardiography


This chapter provides a comprehensive review of the utility of epicardial mapping and ablation in patients with ventricular tachycardia (VT) related to structural heart disease. Epicardial mapping has revolutionized the approach to VT ablation in the setting of left and right ventricular cardiomyopathy, as well as Chagas' disease. The distribution of arrhythmia substrate in these disease processes is frequently complex, often with intramural components. Regardless of the etiology of cardiomyopathy, regions of scar are characterized with electroanatomical mapping by both low electrogram amplitude and abnormal signal characteristics (i.e., late, split and fractionated signals). Unipolar voltage mapping and intracardiac echocardiography may provide clues to the presence of intramural or epicardial substrate. Specific ECG criteria have been developed that also provide clues to an epicardial site of VT origin. The elimination of VT in these patients often requires substrate-based ablation in addition to traditional mapping during VT.