Spatiotemporal characterization of the transition from sinus rhythm to ventricular fibrillation during an acute ischemic event in the intact human heart.

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Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: Endocardial and Epicardial Repolarization Alternans.

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Presentation transcript:

Spatiotemporal characterization of the transition from sinus rhythm to ventricular fibrillation during an acute ischemic event in the intact human heart by whole-heart sock- mapping Michele Orini, PhD, Peter Taggart, MD, DSc, FRCP, Martin Hayward, MS, FRCS, Pier D. Lambiase, PhD, FRCP, FHRS HeartRhythm Case Reports Volume 3, Issue 5, Pages 259-263 (May 2017) DOI: 10.1016/j.hrcr.2017.01.002 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 A: Evolution of a unipolar electrogram from inside the ischemic region including early sinus rhythm, ventricular pacing, late sinus rhythm, and ventricular tachycardia / ventricular fibrillation. B: Detailed representation of morphologic changes in unipolar electrograms from sites P0 to P3 (see Figure 2) during the progression of ischemia. From interval T1 to T4, site P0 (outside the ischemic region) shows broadening QRS and mild changes in the T wave; P1 (border-zone region) shows progressive activation time (AT) delay (shift in the S wave) and T-wave alternans (TWA); P2–P3 (inside the ischemic region) show ST-segment elevation, AT delay, TWA, QRS alternans, and conduction block. Site P3 also shows QRS fractionation during T2. HeartRhythm Case Reports 2017 3, 259-263DOI: (10.1016/j.hrcr.2017.01.002) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Diagram of the multielectrode sock with circles representing electrodes; B: ST-segment elevation/depression during sinus rhythm prior to ventricular pacing; C: Maximum activation time (AT) delay; D: T-wave alternans (TWA); E: QRS alternans (QRSA); F: conduction block. Parameters in C–F are derived from recordings during pacing. The average magnitudes of QRSA and TWA are measured as multiples of the level of statistical significance (V/Vth). The white star represents the pacing site. Points P0–P3 mark cardiac sites outside, at the border zone of, and inside the ischemic region, respectively. Unipolar electrograms from these sites are reported in Figure 1. LV = left ventricle; RV = right ventricle. HeartRhythm Case Reports 2017 3, 259-263DOI: (10.1016/j.hrcr.2017.01.002) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Temporal evolution of electrophysiological abnormalities. A: Propagation of alternans throughout the epicardium, described as the number of sites with significant QRS alternans (QRSA) and T-wave alternans (TWA). B: Distribution of activation time (AT) delay throughout the epicardium. IQR = interquartile range; med = median. C: Temporal evolution of proportion of sites showing concordant alternans (gray region indicating the same BA patterns, where the T-wave amplitude of the odd beat is larger than that of the even beat) and discordant alternans (red region indicating opposite AB pattern). D: TWA magnitude over time. HeartRhythm Case Reports 2017 3, 259-263DOI: (10.1016/j.hrcr.2017.01.002) Copyright © 2017 Heart Rhythm Society Terms and Conditions