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Human Left Ventricular Endocardial Activation Mapping Using a Novel Noncontact Catheter

1997; Lippincott Williams & Wilkins; Volume: 95; Issue: 6 Linguagem: Inglês

10.1161/01.cir.95.6.1658

1524-4539

Nicholas S. Peters, Warren M. Jackman, Richard J. Schilling, Graydon Beatty, D. Wyn Davies,

ECG Monitoring and Analysis

HomeCirculationVol. 95, No. 6Human Left Ventricular Endocardial Activation Mapping Using a Novel Noncontact Catheter Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBHuman Left Ventricular Endocardial Activation Mapping Using a Novel Noncontact Catheter Nicholas S. Peters, Warren M. Jackman, Richard J. Schilling, Graydon Beatty and D. Wyn Davies Nicholas S. PetersNicholas S. Peters , Warren M. JackmanWarren M. Jackman , Richard J. SchillingRichard J. Schilling , Graydon BeattyGraydon Beatty and D. Wyn DaviesD. Wyn Davies Originally published18 Mar 1997https://doi.org/10.1161/01.CIR.95.6.1658Circulation. 1997;95:1658–1660The patient was a 39-year-old male who had recurrent sustained monomorphic ventricular tachycardia, satisfying the electrocardiographic criteria for fascicular tachycardia, in a structurally normal heart.These isopotential maps were acquired from the patient's left ventricle during an otherwise routine electrophysiology study by deploying a catheter-mounted multielectrode array consisting of a wire braid on the surface of an 8-mL balloon (Endocardial Solutions Inc). Without endocardial contact, this system uses inverse solution mathematics (boundary-element method) to reconstruct 3360 "virtual" electrograms onto a shell model of the endocardium. A manually selected line of virtual electrograms shows a normal sequence of high-frequency potentials consistent with fascicular activation during sinus rhythm, which correlates with the activation process shown by isopotential mapping (Fig 1). During a brief, nonsustained episode of the patient's clinical tachycardia (Fig 2) the sequence of these presumed fascicular potentials is clearly altered in a manner consistent with the diagnosis of fascicular tachycardia and corresponding to an altered activation sequence on isopotential mapping. Despite its short duration, the tachycardia could be characterized in a single beat.This case illustrates the use of a novel catheter-based technology in acquiring extensive simultaneous data to create unique maps of endocardial activation during electrophysiological study of a conscious patient.From the Department of Cardiology (N.S.P., R.J.S., D.W.D.), St Mary's Hospital and Imperial College School of Medicine, London, UK; Department of Medicine (W.M.J.), University of Oklahoma Health Sciences Center, Oklahoma City, Okla; and Endocardial Solutions, Inc (G.B.), Saint Paul, Minn.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Sinus rhythm: A sequence of isopotential maps of the left ventricular endocardium (purple) modeled to the patient's chamber dimensions and opened along its anteroseptal margin. The location of the multielectrode array is represented by the yellow ellipsoid. Surface ECG lead I and selected virtual electrograms from a line following fascicular activation (I-P on the map) are shown beneath each map. The timing of each map is indicated by the white cursor, which progresses through the presystolic fascicular potentials (A and B). Fascicular activation propagates toward the apex, where it initiates ventricular activation (C).Download figureDownload PowerPoint Figure 2. Fascicular tachycardia: During tachycardia, the fascicular activation sequence is altered, starting near the left ventricular apex (A) and propagating toward the His bundle (B). This rapid retrograde fascicular activation is closely followed by ventricular activation (C). The relative delay in right ventricular activation produces a QRS complex with right bundle-branch block pattern in ECG lead I.This work was supported by the British Heart Foundation.FootnotesCorrespondence to Dr Nicholas S. Peters, Department of Cardiology, St Mary's Hospital, Praed St, London W2 1NY, UK. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By LEMERY R (2012) Interventional Electrophysiology at the Crossroads: Cardiac Mapping, Ablation and Pacing Without Fluoroscopy, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2012.02373.x, 23:10, (1087-1091), Online publication date: 1-Oct-2012. 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FENICI R, PESOLA K, KORHONEN P, MAKIJARVI M, NENONEN J, TOIVONEN L, FENICI P and KATILA T (1998) Magnetocardiographic Pacemapping for Nonfluoroscopic Localization of Intracardiac Electrophysiology Catheters, Pacing and Clinical Electrophysiology, 10.1111/j.1540-8159.1998.tb01207.x, 21:11, (2492-2499), Online publication date: 1-Nov-1998. March 18, 1997Vol 95, Issue 6 Advertisement Article InformationMetrics Copyright © 1997 by American Heart Associationhttps://doi.org/10.1161/01.CIR.95.6.1658 Originally publishedMarch 18, 1997 Advertisement