Electro-Tomographic Mapping with Principal Component Referenced Unipoles and Perpendicular Bipoles.
Despite major advances in electro-anatomical mapping technology, we continue to be limited by mapping catheters roving the two-dimensional surface to define what is a complex three-dimensional myocardial activation pattern. Although inferences may be made by simultaneous mapping of the endocardial and epicardial space,1 true intramural activation patterns and its contribution to the surface electrode cannot yet be resolved. The Pennsylvania peel technique, pioneered by Josephson and colleagues,2,3 demonstrated the potential of surgical “peeling back” of the myocardium to differentiate the contribution of superficial and deeper layers within complex multicomponent signals.