Kc. Man et al., ACCURACY OF THE UNIPOLAR ELECTROGRAM FOR IDENTIFICATION OF THE SITE OF ORIGIN OF VENTRICULAR ACTIVATION, Journal of cardiovascular electrophysiology, 8(9), 1997, pp. 974-979
Introduction: The purpose of this study was to determine the accuracy
of the unipolar electrogram for identifying the earliest site of ventr
icular activation, The earliest site of ventricular activation may be
identified with the unipolar electrogram by the absence of an R wave,
However, the accuracy of this technique is unknown, Methods and Result
s: A single ventricular premature complex was induced mechanically at
the tip of an electrode catheter to simulate a ventricular premature d
epolarization site of origin, Unipolar electrograms were recorded from
the right ventricular septum at the tip electrode and at 2, 5, 8, and
11 mm from the electrode tip in 20 patients, No R waves were detected
at the ventricular premature depolarization site of origin, R waves w
ere detected in 4 of 20 patients (20%) at 2 mm from the tip electrode
and 7 of 20 patients (35%) at 5, 8, and 11 mm from the tip electrode,
An R wave was not observed at distances. 11 mm from the site of tachyc
ardia origin in 13 of 20 patients (65%), Conclusions: While an R wave
in the unipolar electrogram can be seen as close as 2 mm from the site
of impulse origin, the absence of an R wave as an indicator of the si
te of impulse origin in the right ventricle is highly inaccurate, Ther
efore, the absence of an R wave in the unipolar electrogram is unlikel
y to be an adequate guide for identification of an effective target si
te for ablation of right ventricular tachycardia.