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Figure 2 Dynamic Substrate Map

Dynamic substrate map (DSM) of the right ventricle (patient as in Fig. 1) during sinus rhythm; geometry of the right ventricle has been reconstructed (30° right anterior oblique view). The scale on the left side shows the ratio of the peak negative voltage through the cardiac cycle. Negative voltage is displayed on the endocardial surface with white illustrating low-peak negative voltage (<25% of the largest unipolar deflection) and purple the most negative peak voltage (>57.5%). The zone between 25% and 57.5% is displayed in intermediate colors. Two areas of low-peak negative voltage (<35%) can be identified between the right anterior wall and the right ventricular outflow tract and between the tricuspid valve annulus and the right ventricular apex. A critical channel of electrical conduction can be suspected between the 2 low-voltage areas (arrows). Aneurysm = right ventricular outflow tract aneurysm; anterior = anterior right ventricular free wall; lateral = right ventricular lateral wall; RVA/Apex = right ventricular apex; TV6 = tricuspid valve annulus at 6 o’clock position; 6 to 10 = localization of virtual catheter electrograms.