Myocardial laser therapy based on electromechanical mapping

Percutaneous myocardial laser therapy is a new strategy for myocardial reva scularization in patients with end-stage coronary artery disease. The laser impulse which is applied via a catheter creates small channels into ischem ic myocardium from the endocardial surface. Different mechanisms such as an giogenesis, improved blood flow via open channels or neural stunning are di scussed as the underlying mechanism. Precise identification and maneuvering of the laser catheter to the target zone is of crucial importance. By using a novel catheter-based, non-fluoroscopic, three-dimensional endoca rdial mapping system (NOGA(TM), Biosense-Webster Co.) accurate simultaneous assessment of both local electrical activity and regional contractility ca n be obtained. The analysis of uni- or bipolar voltage and linear local sho rtening allows an exact differentiation of scar tissue from viable myocardi um. In addition, due to the high spatial resolution of the NOGA(TM) system the application of laser channels at the same site can be avoided, which in creases the safety of the procedure. To assess the efficacy of the NOGA(TM) based myocardial lasing procedure a multicenter randomized study (Euro-dir ect) is presently underway.