Pfhm. Van Dessel et al., Relation between body surface mapping and endocardial spread of ventricular activation in postinfarction heart, J CARD ELEC, 12(11), 2001, pp. 1232-1241
Citations number
28
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Body Surface Mapping and Endocardial Activation Patterns. Introduction: Bod
y surface mapping (BSM) can be used to identify the site of earliest endoca
rdial activation of ventricular tachycardias (VTs). The multielectrode QRS
morphology during VT is determined by both the site of earliest activation
and the subsequent spread of electrical activation through the ventricles.
This study investigated the relationship between the site of earliest endoc
ardial activation, endocardial spread of activation, and the morphology of
the multielectrode surface map in patients with remote myocardial infarctio
n.
Methods and Results: In 14 patients with VT late (8.2 +/-5.2 years) after m
yocardial infarction, BSM and simultaneous left ventricular 64-site basket
endocardial mapping was performed during a total of 17 monomorphic VTs. In
addition, multisite pacing by sequential use of the 64 basket electrodes wa
s performed in 9 patients. BSM and basket mapping revealed the same endocar
dial breakthrough sites in 8 (47%) of 17 VTs and 189 (59%) of 322 pacing si
tes; adjacent sites were found in 2 (12%) of 17 VTs and 36 (11%) of 322 pac
ing sites. Large zones of conduction block explained the mismatch in locali
zation in 2 (12%) of 17 VTs and 52 (16%) of 322 pacing sites. Regional diff
erences in endocardial electrogram amplitudes were found as a cause for dis
similarity in 3 (18%) of 17 VTs and 73 (23%) of 322 pacing sites. Multiple
endocardial breakthrough sites were found in 1 (6%) of 17 VTs and 8 (2%) of
322 pacing sites Finally, an epicardial exit site was suggested in 3 (18%)
of 17 VTs as an explanation for mismatch, as no early endocardial activity
could be recorded.
Conclusion: Zones of conduction block, regional differences in signal ampli
tude, and multiple endocardial breakthrough sites are frequent causes for m
ismatch between BSM and basket catheter activation mapping.