Endocardial catheter mapping in patients in sinus rhythm: relationship to underlying heart disease and ventricular arrhythmias.

Abstract

Catheter mapping during sinus rhythm was performed in 132 patients with coronary artery disease and 26 patients with congestive noncoronary cardiomyopathy. Each of the patients had a clinical history of one of the following: no ventricular arrhythmia, nonsustained ventricular tachycardia, cardiac arrest, or sustained ventricular tachycardia. The characteristics of the endocardial electrogram and other measured indexes of slow endocardial conduction were compared between patients with different types of disease and in different arrhythmia groups to determine if differences existed. The cardiomyopathic group had a higher percent of normal endocardial electrograms than the coronary artery disease group, with no evidence of slow endocardial conduction. The sustained ventricular tachycardia group exhibited a greater percent of abnormal endocardial electrograms and more evidence of slow endocardial conduction, distinguishing this group from the three other arrhythmia groups. We conclude the following: (1) No. 4, 645452, 1986. LEFT VENTRICULAR mapping in individuals in sinus rhythm has been performed in a variety of patient groups, including those with a normal left ventricle,'-' conduction defects,8-14 coronary artery disease with or without ventricular tachycardia,'2-22 and hypertrophic cardiomyopathy.23 These studies primarily described activation patterns only, although a few attempted to quantitatively and qualitatively characterize local elec-

Characterization of Endocardial Electrophysiological Substrate in Patients With Nonischemic Cardiomyopathy and Monomorphic Ventricular Tachycardia

“…The voltage maps constructed from several hundred sampled sites, and provided insight into the size and location of endocardial abnormalities that were not previously attainable with conventional mapping technologies. 6,7 The endocardial substrate in this setting is marked by modest distribution of abnormal electrogram recordings with low-voltage signals, ranging from 6% to 48% of the LV endocardial surface, but uncommonly involving more than 25% of the total endocardial surface area. Furthermore, in patients with nonischemic cardiomyopathy, the predominant distribution of abnormal endocardial electrogram recordings is located at the left ventricular base, frequently involving the perivalvular regions.…”

“…Earlier studies suffered from limited sampling and provided only limited information. 6,7 Magnetic electroanatomical mapping couples high-density electrogram recordings to a spatial display of anatomy. 8 The purpose of this study was (1) to characterize the endocardial substrate in patients with nonischemic LV cardiomyopathy and monomorphic VT using catheter based voltage electroanatomical mapping, and (2) to correlate the endocardial abnormalities to the site of origin of VT.…”

Mark E Josephson: A Tribute to His Work on Ventricular Arrhythmias

“…Abnormal, late, split and fractionated electrograms, diastolic activation and continuous electrical activity would become part of the electrophysiology lexicon in describing the VT substrate and circuit. [1][2][3] This early work also revealed the subendocardium to be a critical component of most post-MI VTs. This would lead to the surgical 'peeling' of the subendocardial layer of infarcted myocardium extending from the edge of the more densely scarred aneurysm to eliminate VT. 4,5 The 'Pennsylvania Peel' was established as the surgical technique to cure infarct-related VT.…”

“…Abnormal, late, split and fractionated electrograms, diastolic activation and continuous electrical activity would become part of the electrophysiology lexicon in describing the VT substrate and circuit. [1][2][3] This early work also revealed the subendocardium to be a critical …”

Diagnostic implications of spectral and temporal analysis of the entire cardiac cycle in patients with ventricular tachycardia.

“…Results [44][45][46] These electrophysiological derangements contribute to the QRS complex, ST segment, and T wave of signal-averaged ECGs; therefore, it is not surprising that they appear detectable by frequency analysis of the entire cardiac cycle.…”