What is atrioventricular (AV) mapping?

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Last updated: August 17, 2026 • View editorial policy

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What is AV Mapping?

AV mapping is an electrophysiological technique used during cardiac catheter procedures to identify and characterize the electrical activation patterns and conduction properties of the atrioventricular (AV) node region and surrounding structures, particularly within the triangle of Koch.

Core Concept

AV mapping involves the systematic recording of electrical signals from the AV junction area to:

  • Identify the location and function of fast and slow AV nodal pathways in patients with atrioventricular nodal reentrant tachycardia (AVNRT) 1
  • Locate accessory pathways (APs) that bypass the normal AV conduction system, requiring left heart mapping via retrograde aortic or trans-septal approaches 2
  • Define the anatomical and electrical substrate for arrhythmias involving the AV junction

Technical Approach

Traditional Mapping

The procedure historically focused on recording potentials within the triangle of Koch on the right atrial septum, identifying:

  • Fast pathway potentials (anteriorly located atrial connections)
  • Slow pathway potentials (posteriorly located atrial connections) 1

Modern High-Density Mapping

Recent advances using three-dimensional electroanatomic mapping systems have revolutionized AV mapping by enabling 3, 4:

  • More detailed acquisition of electrophysiological potentials within the triangle of Koch
  • Identification of low-voltage areas during sinus rhythm
  • Detection of fractionated potentials during tachycardia
  • Mapping of activation patterns that serve as optimal targets for ablation
  • Bilateral septal mapping (both right and left sides) to comprehensively characterize the circuit 4

Clinical Applications

AV mapping is essential for:

  1. AVNRT ablation: Identifying slow pathway potentials to guide selective ablation without producing complete AV block 1, 3
  2. Accessory pathway ablation: Locating the precise insertion points of bypass tracts 2
  3. Understanding reentrant circuits: Defining the complete activation sequence during tachycardia 4

Training Requirements

Competency in AV mapping requires substantial procedural experience. Trainees should participate in at least 75 supraventricular tachycardia (SVT) ablation procedures to develop proficiency in catheter placement, programmed electrical stimulation, endocardial mapping, and data interpretation 2.

Important Caveats

  • Anatomical complexity: The AV junction involves intricate three-dimensional structures with heterogeneous electrical properties 5
  • Technology dependence: While high-density mapping provides superior detail, detailed anatomical knowledge remains essential for safe and efficient procedures 5
  • Bilateral assessment: Mapping only the right septal side may be insufficient; left-sided mapping through the aorta can provide complementary information 4

References

4
Research

High-resolution mapping of the circuit of typical atrioventricular nodal reentrant tachycardia.

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2024

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.