The CARTO-XP ® version allows the system to review the 8 previous mapping cycles at each point. Furthermore, the usefulness of mapping becomes more apparent as we gain experience and are able to use it more often. 10 Mapping should be reserved for the most complex substrates, which are appearing more frequently. Such studies should not be done on unselected consecutive populations. As with other systems, few randomized studies have been carried out to back up its use. The technique is costly because it requires a special catheter with a sophisticated sensor embedded in its distal electrode and this may limit its use in smaller laboratories. 8,9 Conventional mapping is often limited by the display of information, and it is not unusual to have to subsequently correct by hand the activation times of certain endocardial points. In recent years, in our experience, this system has become an important tool in the ablation of substrates of ventricular and atrial tachycardias. Such mapping is almost essential in techniques such as circumferential ablation of pulmonary veins, for which the CARTO system provides the best definition of the substrate. The relevant electrophysiological information that identifies early activation (activation maps), reentrant circuits (propagation maps) or regions of endocardial scarring that mark tissue isthmuses (voltage maps) can be presented as an image that facilitates the integration of functional and anatomical information, particularly in complex mapping. Internationally, the CARTO system is the most widely used: 169 citations since 1997 in MEDLINE describe clinical use of this system-well ahead of the 13 citations for the LocaLisa system in the same database.Įlectroanatomical mapping with the CARTO system allows simultaneous, point-by-point, acquisition of activation, propagation and endocardial voltage maps in different arrhythmic substrates, with a complete three-dimensional chamber reconstruction. 7 The CARTO ®2 and ENSITE ® systems are more widely used in Spanish laboratories than other systems. 6 One year later, the number of such systems available in Spain had doubled. They were introduced into Spain slowly at first-in 2001, only 26% of Spanish laboratories had any sort of navigation system, and the use of these systems was limited (only 7 out of 182 patients with atrial tachycardias underwent procedures with such systems). Electroanatomical mapping with the CARTO ®2 system (Biosense, CordisWebster), noncontact mapping 3 (ENSITE ® Endocardial Solutions Inc.), the LocaLisa ®4 system (Medtronic), and 3-dimensional real-time positioning 5 (RPM ® Real-Time Position Management System Boston Scientific, S.A.) are currently the main technical developments applicable in clinical electrophysiology. 1 This started to change towards the end of the 90s with reports of the first clinical applications of the so-called navigation systems, with computerized mapping independent of fluoroscopic control. The position of substrates and electrodes with respect to the cardiac shadow and bone structures on an essentially 2-dimensional image was the only imaging support for the electrophysiologist interpreting anatomical localization. For years, fluoroscopy was the only way that arrhythmic substrates could be located and the spatial position of catheter electrodes determined in clinical electrophysiology.
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