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From Signals to Colours: A Case-based Atlas of Electroanatomic Mapping in Complex Atrial arrhythmias

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What is a complex case? Although the concept of what is complex may be personal, there is a common sense of complexity in electrophysiology. In most cases, a complex case involves a patient who comes or is referred after a single or multiple unsuccessful procedures in other centres and is still suffering from the same or a similar arrhythmia. Some other cases are expected to be complex prior to the first procedure, because the patient has an acquired or a congenital heart disease and previously underwent complex cardiac surgery. Yet, in other circumstances, the case becomes complex directly before our eyes, when, for example, during the electrophysiology procedure we realise that what was expected to be a typical atrial flutter based on surface electrocardiogram turns out to be not dependent on cavotricuspid isthmus conduction and requires solid mapping data in order to be successfully treated. Only in a few cases, very rarely to be honest, is the arrhythmia less complex than expected. In these cases, the main difficulty often arises from the fact that the operator has to stick to the evidence and not be prejudiced by the belief that the case has to be necessarily complex, based on the pre-procedural evaluation.

In 2003, the Project of ElectroAnatomic mapping for Complex Arrhythmia Evaluation (PEACE) was initiated in Italy and coordinated by our Center. This book represent the result of this experience. The aim of the project and therefore of this book was to obtain as much information as possible from electroanatomic mapping in order to obtain a correct diagnosis and define a rational ablation strategy in a “learning before burning” process. In this book, the reader will find very few conventional electrophysiology signal recordings–only those that were deemed necessary. There are many other books and papers, written by brilliant authors, including pioneers in this field, showing conventional tracings in complex arrhythmias.What we want to present in “From Signals to Colours” is the outstanding and unparalleled contribution of electroanatomic mapping in the muddy field of complex atrial arrhythmias. This does not mean that conventional electrophysiology has been forgotten or abolished. Far from being in conflict with what is considered conventional in electrophysiology, electroanatomic mapping is, in fact, based on conventional recordings, and black and white conventional signals are embedded and integrated in a colourcoded electroanatomic map to obtain a more complete and more intuitive display of the electrical activation of a given heart chamber during a given arrhythmia. Some of the results obtained by this project are shown in the 25 cases presented in this book. Basically, this project’s major achievements have been procedure simplification and increased success rate, obtained widely and in a replicable way among centres, when complex arrhythmias are approached.
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