There is much current interest in simultaneous multichannel cardiac mapping. In this paper we give recommendations for the construction of a cardiac mapping system. Because the field of cardiac mapping is relatively young, optimum mapping techniques and all possible applications have not yet been developed. Therefore, the mapping system should be flexible and it should have many capabilities. The system should be digital; if variable gains are used, the amplifiers should be programmable and controlled by a microprocessor. It should be possible to analyze previous recordings and acquire additional recordings simultaneously. The mapping system should be able to record continuously for at least tens of minutes and preferably for hours. The recorded data stream should be a self-contained unit, holding all important electrophysiologic information as well as the recorded electrode signals. The programs should be written in C under a UNIX operating system. A minimum of 64 channels should be used for epicardial or endocardial mapping and a minimum of 128 channels for three-dimensional intramural mapping. The leakage current requirements for multichannel mapping systems are too stringent and should be re-evaluated. The major limitation to progress in cardiac mapping is neither the hardware nor the software; it is the electrode: its construction, its placement, its fixation, and the interpretation of its recordings.

Recording cardiac electrical activity after a countershock has been limited by amplifier saturation. Modifications to our computer-assisted mapping system allowed us to record electrical activity from 56 epicardial electrodes within 5 ms of the end of a countershock. Modifications included the use of solid-state switches to disconnect the filter section of the amplifiers during the shock and changing the low-frequency response of the amplifiers from 0.1 to 10 Hz to filter out large, low-frequency potentials after the shock. Six-millisecond truncated exponential shocks were delivered between the superior vena cava and right ventricular apex through a quadripolar catheter during normal rhythm in seven dogs. As shocks of increasing voltage were delivered during the T-Q interval, progressively more of the epicardium was directly depolarized. A shock of 109 +/- 17 (SD) V directly depolarized the entire epicardium. Shocks of constant voltage were then delivered with increasing prematurity during diastole. As the ventricles became more refractory with increasing shock prematurity, the amount of epicardium depolarized became progressively less. Thus computer-assisted mapping techniques are capable of measuring the area depolarized by a shock during normal rhythm and may be useful during arrhythmias to improve our understanding of defibrillation and cardioversion.

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