Document Detail

Use of electrogram characteristics during sinus rhythm to delineate the endocardial scar in a porcine model of healed myocardial infarction.
MedLine Citation:
PMID:  12776871     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Substrate-based catheter ablation of postmyocardial infarction (post-MI) ventricular tachycardia necessitates electroanatomic definition of the scarred endocardium. We sought to determine whether electrogram criteria during sinus rhythm could identify the location and extent of the myocardial scar by electroanatomic mapping. METHODS AND RESULTS: A porcine model of healed MI was generated by injecting agarose microspheres into the mid left anterior descending coronary artery. At least 4 weeks post-MI, the animals (n = 24) underwent detailed left ventricular endocardial electroanatomic mapping using a 4-mm-tip catheter (BioSense-Webster, Inc.). Based upon mapping data in normal animals, infarcted tissue was defined as bipolar electrogram amplitude < 1.5 mV and electrogram duration > or = 50 msec. Radiofrequency ablation lesions (2-10 per animal) were placed to tag the endocardial borders of the electroanatomic mapping-defined scar. The area of the scar defined by abnormal voltage amplitude was 25.9 +/- 15.4 cm2 (range 6.9-60.5). This area correlated well with that defined as scar by the electrogram duration criteria (26.4 +/- 16 cm2). Of those points remote from the infarct with falsely low voltage amplitude resulting from presumed poor catheter-tissue contact, 94% were correctly identified as normal when using the electrogram duration criteria. Late potentials were observed predominantly along the borders of the infarcted myocardium. The radiofrequency lesions placed to tag the scar borders were located along the scar periphery during gross pathologic examination. CONCLUSION: During normal sinus rhythm, both bipolar electrogram voltage amplitude and electrogram duration criteria are able to help differentiate normal from scarred myocardial tissue. Using these criteria, a detailed reconstruction of the endocardial scar can be rendered by electroanatomic mapping of the heart.
David Wrobleski; Christopher Houghtaling; Mark E Josephson; Jeremy N Ruskin; Vivek Y Reddy
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  14     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-06-02     Completed Date:  2003-10-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  524-9     Citation Subset:  IM    
Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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MeSH Terms
Body Surface Potential Mapping*
Cicatrix / classification*,  pathology,  physiopathology*
Disease Models, Animal
Endocardium / anatomy & histology,  pathology,  physiopathology*
Heart Conduction System / physiology*
Heart Ventricles / anatomy & histology,  pathology,  physiopathology
Models, Cardiovascular
Myocardial Infarction / classification*,  pathology,  physiopathology*
Ventricular Function, Left / physiology
Wound Healing / physiology*
Grant Support
Comment In:
J Cardiovasc Electrophysiol. 2003 May;14(5):530-2   [PMID:  12776872 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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