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Endocardial wave front organization during ventricular fibrillation in humans

Gregory P. Walcott, MD^*,*, G. Neal Kay, MD, FACC^*, Vance J. Plumb, MD, FACC^*, William M. Smith, PhD^*,, Jack M. Rogers, PhD, Andrew E. Epstein, MD, FACC^* and Raymond E. Ideker, MD, PhD, FACC^*,

^* Division of Cardiovascular Diseases, Department of Medicine, , University of Alabama at Birmingham, Birmingham, Alabama, USA and the
Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA.

View larger version (165K): [in a new window]   Figure 1 An anterior-posterior fluoroscopic image of a patient undergoing the implantation of an implantable cardioverter-defibrillator and ventricular fibrillation mapping. A 36-pole catheter is in the left ventricular (LV) cavity. The distal electrodes of the catheter are recording from the antero-lateral wall of the left ventricle (LV). The proximal electrodes of the catheter are recording from the postero-septal wall of the LV. A defibrillation catheter is positioned in the apex of the right ventricle. A six-pole catheter is in the coronary sinus.

View larger version (43K): [in a new window]   Figure 2 Unipolar electrograms recorded from one episode of ventricular fibrillation. The top trace is body surface lead II. The next 36 traces are from the catheter in the left ventricle. Approximately 2 s of data are shown. The time between plus symbols is 100 ms. The diamonds mark the 1-s point in the data. The daggers mark the time when local activation was judged to have occurred.

View larger version (19K): [in a new window]   Figure 3 (A) Activation times from another patient, each plotted as a function of electrode number. The x-axis is time in milliseconds. The y-axis is electrode number. Note that activation fronts propagate for long distances along the catheter. (B) Simulated activation times as a function of electrode number. The same number of activations are plotted as in A. Activations are randomly distributed in time along the catheter.

View larger version (36K): [in a new window]   Figure 4 Recorded electrograms from a third patient during ventricular fibrillation. The top trace is body surface lead II. The next 12 traces are from electrodes 13 through 24 from the 36-pole catheter in the left ventricle (LV). Approximately 2 s of data are shown. These recordings represent the electrical activity from the antero-lateral wall of the LV.

View larger version (16K): [in a new window]   Figure 5 Maximum correlation between the electrogram potentials as a function of distance between electrodes from one patient. Each point represents the maximum cross-correlation from one pair of electrograms. The solid line represents the exponential curve that was fit to the data. The value of lambda, the length constant, is approximately 10 cm for this episode of ventricular fibrillation.

View larger version (18K): [in a new window]   Figure 6 Wave front isolation from one episode of ventricular fibrillation. Activations along the catheter are grouped into a wave front if adjacent activation times are within 0.04 s of each other.