Document Detail

Implantable Defibrillator Electrograms and Origin of Left Ventricular Impulses: An Analysis of Regionalization Ability and Visual Spatial Resolution.
MedLine Citation:
PMID:  22151407     Owner:  NLM     Status:  Publisher    
ICD Electrograms and Origin of Impulses. Introduction: The implantable cardioverter-defibrillator (ICD) electrogram (EG) is a documentation of ventricular tachycardia. We prospectively analyzed EGs from ICD electrodes located at the right ventricle apex to establish (1) ability to regionalize origin of left ventricle (LV) impulses, and (2) spatial resolution to distinguish between paced sites. Methods and Results: LV electro-anatomic maps were generated in 15 patients. ICD-EGs were recorded during pacing from 22 ± 10 LV sites. Voltage of far-field EG deflections (initial, peak, final) and time intervals between far-field and bipolar EGs were measured. Blinded visual analysis was used for spatial resolution. Initial deflections were more negative and initial/peak ratios were larger for lateral versus septal and superior versus inferior sites. Time intervals were shorter for apical versus basal and septal versus lateral sites. Best predictive cutoff values were voltage of initial deflection <-1.24 mV, and initial/peak ratio >0.45 for a lateral site, voltage of final deflection <-0.30 for an inferior site, and time interval <80 milliseconds for an apical site. In a subsequent group of 9 patients, these values predicted correctly paced site location in 54-75% and tachycardia exit site in 60-100%. Recognition of paced sites as different by EG inspection was 91% accurate. Sensitivity increased with distance (0.96 if ≥ 2 cm vs 0.84 if < 2 cm, P  <  0.001) and with presence of low-voltage tissue between sites (0.94 vs 0.88, P  <  0.001). Conclusions: Standard ICD-EG analysis can help regionalize LV sites of impulse formation. It can accurately distinguish between 2 sites of impulse formation if they are ≥2 cm apart. (J Cardiovasc Electrophysiol, Vol. pp. 1-9).
Jesús Almendral; Felipe Atienza; Estrella Everss; Loreto Castilla; Esteban Gonzalez-Torrecilla; José Ormaetxe; Angel Arenal; Mercedes Ortiz; Margarita Sanromán-Junquera; Inmaculada Mora-Jiménez; José M Bellon; José L Rojo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-8
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Wiley Periodicals, Inc.
Cardiology Department, Hospital General Universitario Gregorio Marañon Electrophysiology Unit, Hospital de Madrid Group, University CEU-San Pablo Department of Signal Theory and Communications, University Rey Juan Carlos Cardiology Department, Hospital de Basurto, Bilbao Research Foundation, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
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