Use of noninvasively determined right ventricular epicardial breakthrough in clinical diagnosis and understanding

Liebman, Jerome

doi:10.1016/0022-0736(90)90077-f

Cited by 4 publications

(11 citation statements)

References 23 publications

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“…In this study, one patient, a 2‐year‐old girl, demonstrated LV breakthrough. The preoperative map exhibited the niche at the lower part of the left anterior chest 37 ms after QRS complex onset, which was markedly delayed compared with normal controls, indicating an advanced degree of right bundle branch block 8,13 . At 3 months and even 30 months postoperatively, her QRS isopotential map showed LV breakthrough.…”

Section: Resultsmentioning

confidence: 89%

“…The negative potential areas covered the back and later the right anterior chest. About 20 ms after QRS complex onset, a niche on the anterior chest appeared on the median line, which reflected the onset of RV breakthrough 7–11 . In normal controls, a niche appeared 23.4 ± 4.0 ms after QRS complex onset, around the upper part of the sternum in the rightward and upward direction of the maximum.…”

Section: Resultsmentioning

confidence: 96%

“…Typical findings in BSMs during the depolarization process in preoperative ASD patients were compatible with delayed RV conduction 5–8,13,14 . Blumenschein et al 5 showed delayed RV excitation in patients with ASD.…”

Section: Discussionmentioning

confidence: 95%

“…The common standard ECG findings in patients with ASD are the rsR' pattern in lead V 1 1 and isolated negative T wave in the precordial leads 2–4 . Various studies have examined the possible genesis of these ECG abnormalities in patients with ASD, which mainly are attributed to abnormalities in depolarization 5–8 . However, the possibility of abnormal repolarization processes associated with these ECG changes has not been explored, particularly in association with their resolution following intracardiac repair with hemodynamic improvement.…”

Section: Introductionmentioning

confidence: 99%

“…BSM depicts sequential changes in local potentials and complex activation fronts, which are useful in evaluating separate simultaneous activation processes in the RV and left ventricle (LV) 9–14 . Conduction delay in the RV is explored using BSMs of patients with RV overload and their findings compared with those with right bundle branch block 7,8,13 . However, how resolution of abnormal repolarizations in ASD occurs after cardiac repair with hemodynamic improvement in RV overload has not been explored.…”

Section: Introductionmentioning

confidence: 99%

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Resolution of Abnormal Body Surface Maps in Children with Atrial Septal Defect after Intracardiac Repair

Asano

Izumida

Kawano³

et al. 2004

Cardiovasc electrophysiol

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Introduction: The genesis of repolarization abnormalities of ECG waveforms in atrial septal defect (ASD), which typically is characterized by right ventricular (RV) volume overload, has not been explored, particularly in association with postoperative hemodynamic improvement. The aim of this study was to evaluate the effects of reduced RV overload after ASD closure on depolarization and repolarization abnormalities on body surface maps (BSMs). Methods and Results: BSMs of 14 children with ASD were recorded preoperatively and at early postoperative (1–6 months) and late postoperative (>9 months) stages. BSMs of 31 age‐matched healthy children were studied as normal controls. Before intracardiac repair, QRS isopotential maps of children with ASD showed delayed RV breakthrough and subsequent rightward enlargement of the positive area with a maximum shifting to the right. Delayed conduction of the RV, particularly at the outflow tract area, was noted. The preoperative QRST isointegral maps exhibited the two‐maximum pattern reflecting repolarization abnormality. The delayed appearance of breakthrough and delayed RV conduction on the QRS isopotential maps persisted from the preoperative to the late postoperative stage, whereas the two‐maximum pattern on the QRST isointegral maps normalized to the one‐dipole pattern at an early stage after repair. Conclusion: Abnormal repolarization parameters in ASD patients showed rapid improvement postoperatively, despite the persistence of depolarization abnormalities. Therefore, the two‐maximum pattern on the QRST isointegral maps indicates a primary T wave change due to hemodynamic RV volume overload.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 96%