Document Detail


A novel lead configuration for optimal spatio-temporal detection of intracardiac repolarization alternans.
MedLine Citation:
PMID:  21430127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Electric alternans is a pattern of variation in the shape of ECG waveform that occurs every other beat. In humans, alternation in ventricular repolarization, known as repolarization alternans (RA), has been associated with increased vulnerability to ventricular tachycardia/fibrillation and sudden cardiac death.
METHODS AND RESULTS: This study investigates the spatio-temporal variability of intracardiac RA and its relationship to body surface RA in an acute myocardial ischemia model in swine. We developed a real-time multichannel repolarization signal acquisition, display, and analysis system to record ECG signals from catheters in the right ventricle, coronary sinus, left ventricle, and epicardial surface before and after circumflex coronary artery balloon occlusion. We found that RA is detectable within 4 minutes after the onset ischemia and is most prominently seen during the first half of the repolarization interval. Ischemia-induced RA was detectable on unipolar and bipolar leads (both in near- and far-field configurations) and on body surface leads. Far-field bipolar intracardiac leads were more sensitive for RA detection than body surface leads, with the probability of body surface RA detection increasing as the number of intracardiac leads detecting RA increased, approaching 100% when at least three intracardiac leads detected RA. We developed a novel, clinically applicable intracardiac lead system based on a triangular arrangement of leads spanning the right ventricular and coronary sinus catheters, which provided the highest sensitivity for intracardiac RA detection when compared with any other far-field bipolar sensing configurations.
CONCLUSIONS: In conclusion, intracardiac alternans, a complex spatio-temporal phenomenon associated with arrhythmia susceptibility and sudden cardiac death, can be reliably detected through a novel triangular right ventricular-coronary sinus lead configuration.
Authors:
Eric H Weiss; Faisal M Merchant; Andre d'Avila; Lori Foley; Vivek Y Reddy; Jagmeet P Singh; Theofanie Mela; Jeremy N Ruskin; Antonis A Armoundas
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-03-23
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  4     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-15     Completed Date:  2011-09-01     Revised Date:  2014-09-14    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  407-17     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
Body Surface Potential Mapping / methods*
Death, Sudden, Cardiac / etiology*,  prevention & control
Defibrillators, Implantable*
Disease Models, Animal
Heart / physiopathology*
Heart Conduction System / physiopathology*
Male
Swine
Tachycardia, Ventricular / complications,  diagnosis*,  therapy
Grant Support
ID/Acronym/Agency:
1R01HL103961/HL/NHLBI NIH HHS; 1R21AG035128/AG/NIA NIH HHS; R01 HL103961/HL/NHLBI NIH HHS; R01 HL103961-01/HL/NHLBI NIH HHS; R21 AG035128/AG/NIA NIH HHS; R21 AG035128-01A1/AG/NIA NIH HHS; R21 AG035128-02/AG/NIA NIH HHS
Comments/Corrections

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