Nonfluoroscopic Endoventricular Electromechanical Three-Dimensional Mapping

onfluoroscopic electromechanical mapping (NOGA™, Biosense-Webster, a Johnson & Johnson Company) is a recently developed technique that enables the acquisition of on-line information on the electrical and mechanical endoventricular functioning of myocardial tissue. 1 The rationale for this new technique is 2-fold. First, none of the currently available in-cathlab methods can distinguish viable from non-viable myocardium. Accepted techniques, such as radionuclide scintigraphy and dobutamine stress echocardiography, may not be readily available, and can not be performed in the cathlab. Second, applications such as myocardial laser revascularization or intramyocardial gene-injection may prove cumbersome when performed using echocardiography or fluoroscopy with only 2-dimensional (2-D) projections available on-line. 1 A major pitfall of these latter techniques is indeed the inability to accurately associate the 2-D positioning with a specific endocardial site, quite apart from the high X-ray exposure for both patient and physician when using fluoroscopy. 2 Although clinical application of on-line 3-dimensional (3D) echocardiography and magnetic resonance imaging is underway, until recently there has not been a technique for real-time 3-D guiding of intervention tools and assessment of myocardial electromechanical functioning. Nonfluoroscopic electromechanical mapping has become the first navigation technique to accurately determine the trajectory of a tool inside the human heart, to guide the interventional device to a specific site, and to meticulously couple functional and anatomical properties. 1 In this overview, we shall describe the NOGA ™ system components, the left ventricular mapping technique, the current experimental and clinical data available, the ongoing trials and the possible future applications of this technique.