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EXPERIMENTAL STUDY

Noninvasive electrocardiogram imaging of substrate and intramural ventricular tachycardia in infarcted hearts

^a Cardiac Bioelectricity Research and Training Center (CBRTC) and the Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
^b Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, USA

Manuscript received November 20, 2000; revised manuscript received August 6, 2001, accepted August 24, 2001.

^* Reprint requests and correspondence: Dr. Yoram Rudy, Cardiac Bioelectricity Center, Wickenden 509, Case Western Reserve University, Cleveland, Ohio 44106-7207 USA.
yxr{at}po.cwru.edu

OBJECTIVES: The goal of this study was to experimentally evaluate a novel noninvasive electrocardiographic imaging modality during intramural reentrant ventricular tachycardia (VT).

BACKGROUND: Myocardial infarction and subsequent remodeling produce abnormal electrophysiologic substrates capable of initiating and maintaining reentrant arrhythmias. Existing noninvasive electrocardiographic methods cannot characterize abnormal electrophysiologic substrates in the heart or the details of associated arrhythmias. A noninvasive method with such capabilities is needed to identify patients at risk of arrhythmias and to guide and evaluate therapy.

METHODS: A dog heart with a four-day-old infarction was suspended in a human shaped torso-tank. Measured body surface potentials were used to noninvasively compute epicardial potentials, electrograms and isochrones. Accuracy of reconstruction was evaluated by direct comparison to measured data. Reconstructions were performed during right atrial pacing and nine cycles of VT.

RESULTS: Noninvasively reconstructed potential maps, electrograms and isochrones identified: 1) the location of electrophysiologically abnormal infarct substrate; 2) the epicardial activation sequences during the VTs; 3) the locations of epicardial breakthrough sites; and 4) electrophysiologic evidence for activation of the Purkinje system and septum during the reentrant beats.

CONCLUSIONS: Electrocardiographic imaging can noninvasively reconstruct electrophysiologic information on the epicardium during VT with intramural reentry, provide information about the location of the intramural components of reentry and image abnormal electrophysiologic substrates associated with infarction.

Abbreviations and Acronyms   CC   correlation coefficient   –dV/dtmax   time of maximum negative derivative   ECGI   electrocardiographic imaging   LAD   left anterior descending coronary artery   LV   left ventricle   MI   myocardial infarction   RA   right atrium   RV   right ventricle   TTC   triphenyltetrazolium chloride   VT   ventricular tachycardia

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