Impact of changing activation sequence on bipolar electrogram amplitude for voltage mapping of left ventricular infarcts causing ventricular tachycardia.
- Brunckhorst CB Cardiovascular Center, University Hospital Zurich, Switzerland. corinna.brunckhorst@usz.ch
- Delacretaz E
- Soejima K
- Maisel WH
- Friedman PL
- Stevenson WG
- 2005-03-04
Published in:
- Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - 2005
Aged
Body Surface Potential Mapping
Cardiac Catheterization
Cardiac Pacing, Artificial
Catheter Ablation
Electrocardiography
Heart Conduction System
Humans
Male
Myocardial Infarction
Prospective Studies
Tachycardia, Ventricular
English
INTRODUCTION
Wavefront direction is a determinant of bipolar electrogram amplitude that could influence identification of low amplitude regions indicating infarction or scar.
METHODS
To assess the importance of activation sequence on electrogram amplitude 11 patients with prior infarction and ventricular tachycardia were studied. At 819 left ventricular sites bipolar electrograms were recorded during atrial pacing and ventricular pacing, followed by unipolar pacing with a stimulus of 10 mA at 2 ms. Sites with a pacing threshold > 10 mA were designated electrically unexcitable scar.
RESULTS
Areas of low voltage (< or =1.5 mV) were present in all patients. Atrial paced and ventricular paced electrogram amplitudes were strongly correlated (r = 0.77; P < 0.0001). Changing the activation sequence (from atrial pacing to ventricular pacing) produced a > 50% change in electrogram amplitude at 28% of sites and a > 100% change at 10% of sites, but only 8% of sites had an electrogram amplitude classified as abnormal (< or =1.5 mV) with one activation sequence and normal (> 1.5 mV) with the other activation sequence. Electrically unexcitable scar (6% of sites) was associated with lower electrogram amplitude but could not be reliably identified based on electrogram amplitude alone for either activation sequence.
CONCLUSION
Voltage maps created with bipolar recordings using these methods should be relatively robust depictions of abnormal ventricular regions despite variable catheter orientation and activation sequences that might be produced by different rhythms.
Wavefront direction is a determinant of bipolar electrogram amplitude that could influence identification of low amplitude regions indicating infarction or scar.
METHODS
To assess the importance of activation sequence on electrogram amplitude 11 patients with prior infarction and ventricular tachycardia were studied. At 819 left ventricular sites bipolar electrograms were recorded during atrial pacing and ventricular pacing, followed by unipolar pacing with a stimulus of 10 mA at 2 ms. Sites with a pacing threshold > 10 mA were designated electrically unexcitable scar.
RESULTS
Areas of low voltage (< or =1.5 mV) were present in all patients. Atrial paced and ventricular paced electrogram amplitudes were strongly correlated (r = 0.77; P < 0.0001). Changing the activation sequence (from atrial pacing to ventricular pacing) produced a > 50% change in electrogram amplitude at 28% of sites and a > 100% change at 10% of sites, but only 8% of sites had an electrogram amplitude classified as abnormal (< or =1.5 mV) with one activation sequence and normal (> 1.5 mV) with the other activation sequence. Electrically unexcitable scar (6% of sites) was associated with lower electrogram amplitude but could not be reliably identified based on electrogram amplitude alone for either activation sequence.
CONCLUSION
Voltage maps created with bipolar recordings using these methods should be relatively robust depictions of abnormal ventricular regions despite variable catheter orientation and activation sequences that might be produced by different rhythms.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1007/s10840-005-6549-z
- PMID 15744466
- Persistent URL
- https://sonar.ch/global/documents/84889
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