Percutaneous myocardial laser therapy is a new strategy for myocardial revascularization in patients with end-stage coronary artery disease. The laser impulse which is applied via a catheter creates small channels into ischemic myocardium from the endocardial surface. Different mechanisms such as angiogenesis, improved blood flow via open channels or neural stunning are discussed 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 endocardial mapping system (NOGA, Biosense-Webster Co.) accurate simultaneous assessment of both local electrical activity and regional contractility can be obtained. The analysis of uni- or bipolar voltage and linear local shortening allows an exact differentiation of scar tissue from viable myocardium. In addition, due to the high spatial resolution of the NOGA system the application of laser channels at the same site can be avoided, which increases the safety of the procedure. To assess the efficacy of the NOGA based myocardial lasing procedure a multicenter randomized study (Euro-direct) is presently underway.