The Assumptions of Isochronal Cardiac Mapping

Isochronal maps of cardiac activation are commonly used to study the mechanisms and to guide the ablative therapies of arrhythmias. Little has been written about the assumptions implicit in the construction and use of isochronal cardiac maps. These assumptions include the following: (1) the location of the recording electrodes is known with sufficient accuracy to determine the mechanism of an arrhythmia or to guide therapy; (2) a single, discrete activation time can be assigned to each recording electrode location; (3) the presence or absence of activation at an electrode site can be reliably ascertained, and when activation is present, the time of activation can be determined with sufficient accuracy to specify the mechanism of an arrhythmia or to guide therapy; and (4) the recording electrodes are close enough together that the activation sequence can be estimated with sufficient accuracy to determine the mechanism of an arrhythmia or to guide therapy. The manuscript reviews evidence that these assumptions may not always be true, and when they are not, the isochronal map may be misleading.