Electrocardiographic body surface potential mapping in the Wolff-Parkinson-White syndrome. Noninvasive determination of the ventricular insertion sites of accessory atrioventricular connections.

Abstract

The following conclusions were drawn: 1) BSPM using QRS analysis accurately predicts the ventricular insertion site of accessory AV connections in the presence of a delta wave in the electrocardiogram; 2) the ventricular insertion sites of accessory AV connections determined by BSPM and by EPS at surgery were identical or within one mapping site (1.5 cm or less) in all but four of 18 cases; three of the four exceptions had more than one accessory AV connection, and the other had a very broad ventricular insertion; 3) BSPM and EPS locations of the accessory AV connections correlated very well in the 34 cases despite the fact that BSPM determines the ventricular insertion site and EPS determines the atrial insertion site of the accessory AV connection; 4) as suggested by the three cases of multiple accessory AV connections, EPS and BSPM may be complementary since BSPM identified one pathway and EPS identified the other (in the case with a broad ventricular insertion, BSPM and EPS demonstrated different proportions of that insertion); 5) BSPM using ST-T analysis is very much less accurate in predicting the ventricular insertion site of accessory AV connections unless there is marked preexcitation; 6) standard electrocardiography using the Gallagher grid methodology (but with no attempt at stimulating maximal preexcitation) was not as accurate as QRS analysis of BSPM in predicting the ventricular insertion site of the accessory AV connection; however, exact comparison is hampered by the different number and size of the Gallagher and Guiraudon insertion sites; 7) BSPM using QRS analysis appears to be very accurate in predicting right ventricular versus left ventricular posteroseptal accessory AV connections; 8) typical epicardial right ventricular breakthrough, indicative of conduction via the specialized AV conduction system, occurs in all patients with left ventricular free wall accessory AV connections; 9) epicardial right ventricular breakthrough was not observed in cases with right ventricular free wall or anteroseptal accessory AV connections; 10) epicardial right ventricular breakthrough can occur in the presence of posteroseptal accessory AV connections, whether right or left ventricular; and 11) the delay in epicardial right ventricular breakthrough in cases with left ventricular insertion may provide a marker to estimate the degree of ventricular preexcitation.

Confirmation of Novel Noninvasive High-Density Electrocardiographic Mapping With Electrophysiology Study

“…[1][2][3] Our group has participated in this process as well. [4][5][6][7] The aim of the current study was to test the hypothesis that noninvasive epicardial activation mapping is a valid method to provide activation sequences in patients with atrial and ventricular rhythm disorders.…”

Noninvasive electrocardiographic imaging (ECGI) of epicardial activation before and after catheter ablation of the accessory pathway in a patient with Ebstein anomaly

“…Epicardial right ventricular breakthrough (RVBT) is indicative of conduction via the AV node and the Purkinje system. Studies by Liebman et al (15) have shown evidence of lack of epicardial RVBT for WPW right-sided and anteroseptal pathways. This may be explained by the proximity of the AP to the right bundle branch.…”

Additional Data on Body Surface Potential Maps of Ventricular Repolarization in Normal Adults.

“…This method can provide valuable information on such conditions as congenital heart disease,7) right ventricular hypertrophy,8,9) cardiomyopathy,10-12) ventricular conduction disturbances13,14) and arrhythmias. [15][16][17][18][19][20][21] This method has also proved to be particularly useful in the assessment of myocardial infarction in terms of diagnosis,22-27) local_ ization,27-32) complications,) prognosis) and assessment of therapy.38-40) Furthermore, exercise BSPM is one of the promising methods for the detection, localization and evaluation of myocardial ischemia. [41][42][43] Although the potential utility of the BSPM is promising, the clinical data available at this time are still not sufficient to establish perfect diagnostic standards, and a normal data base of the BSPM remains to be established.…”