Intracoronary guidewires used in percutaneous coronary intervention can also be configured to provide temporary ventricular pacing. Trans coronary electrophysiological parameters recorded by employing coronary guidewires may have a potential role in assessing myocardial viability and could provide a means to make an immediate on-table decision about revascularisation. To date, some small studies have demonstrated the safety of this technique in temporary cardiac pacing, but further research is required to refine this approach and establish its clinical utility in myocardial viability assessment. In this review we discuss the potential role of trans coronary electrophysiology in the assessment of myocardial viability.

Percutaneous coronary intervention (PCI) is a widely performed revascularisation procedure for coronary artery disease. Although effective, its reliance on fluoroscopy and iodinated contrast exposes patients and operators to risks of radiation and nephrotoxicity. As PCI techniques have become more complex, interest has grown in imaging methods that reduce dependence on fluoroscopy and contrast. Electro-anatomical mapping systems (EAMS), developed for catheter navigation in electrophysiology, enable real-time three-dimensional visualisation without the need for fluoroscopy or contrast. By adapting coronary guidewires as electrodes, EAMS can reconstruct vessel anatomy and track interventional tools in real time. EAMS have demonstrated feasibility and safety in device implantation, and early studies suggest their applicability to PCI, where they may mitigate radiation and contrast exposure by providing an alternative method for guidewire and stent visualisation. This review provides a narrative overview of current evidence, outlining the technical principles, applications in device implantation, and the emerging role of EAMS in coronary intervention.