Global Endocardial Electrical Restitution in Human Right and Left Ventricles Determined by Noncontact Mapping
Arthur M. Yue, MRCP*,
Michael R. Franz, MD, PhD ,
Paul R. Roberts, MD, MRCP* and
John M. Morgan, MD, FRCP*,*
* Wessex Cardiac Center, Southampton General Hospital, Southampton, United Kingdom
Cardiology Division, Veteran Affairs Medical Center, Washington, DC.
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Figure 1 Schematic diagram showing 16 regional segments in both left and right ventricles (RV) from which data were sampled. RVOT = right ventricular outflow tract.
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Figure 2 Activation-recovery interval (ARI) restitution and slope measurement. (A) Simultaneous measurement of ARIs at three sites in the posterobasal left ventricle during S1-S2 stimulation is shown. ARIs and diastolic intervals (in parentheses) from unipolar virtual electrograms—virtuals 6, 8, 10—are determined using their respective first derivatives (dV/dt)—virtuals 7, 9, 11 at the same sites. Maximum ARI restitution slopes from a right ventricular site (B) and left ventricular site (C) are measured by 16 overlapping least-squares linear segments. LVOT = left ventricular outflow tract; MV = mitral valve.
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Figure 3 Global activation-recovery interval (ARI) restitution curves. Simultaneous restitution curves were constructed at 16 sites in a right ventricle (A) and left ventricle (B). Color labels for the 16 regional segments are illustrated in (C). Locations of the 16 segments are shown in Figure 1.
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Figure 4 Distribution of activation-recovery interval restitution slopes. Maximal restitution slopes are shown in color in the 16 segments of the ventricle in patients 1 to 8. Brown circles = sites of ablation therapy. In patients with idiopathic left ventricular (fascicular) tachycardia (#5 to #7), sites of ablation are located in segments with a restitution slope >1.
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Figure 5 Activation-recovery interval restitution slopes at different diastolic intervals. Mean (±SD) restitution slopes (A) and dispersion of restitution slopes (B) are greatest in the initial 0% to 10% of the restitution curves.
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Figure 6 Global conduction velocity restitution curves from a right ventricle (A) and a left ventricle (B). Measurements are taken from 16 segments in each ventricle at the same sites as in Figure 3. *Magnitude of CV restitution for site 14 of the right ventricle.
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