Circulation, Vol 74, 1334-1345, Copyright © 1986 by American Heart Association
L De Ambroggi, T Bertoni, E Locati, M Stramba-Badiale and PJ Schwartz
Body surface potential maps were recorded from 140 chest leads in 25
patients affected by the idiopathic long QT syndrome (LQTS) and in 25
healthy control subjects matched for age and sex. Potential time integrals
of the QRST and ST-T intervals were calculated at each lead point and
displayed as isointegral (ISOI) maps. The main abnormalities noted on the
QRST and ST-T ISOI maps were one area of negative values larger than normal
in the right anterior and inferior thorax and a complex multipeak
distribution of the integral values. At least one abnormality was present
in 19 (76%) of the patients with LQTS and four (16%) of the control
subjects (p less than .001). Each ISOI map was also represented as a
weighted sum of nine fundamental components (eigenvectors) to detect and
quantitate the nondipolar content. The percent contribution of the
nondipolar eigenvectors (all eigenvectors beyond the third) was
significantly higher in the LQTS group than in the control group (p less
than .005). Specifically, an abnormally high nondipolar content on the QRST
ISOI maps was observed much more frequently for patients with LQTS than for
control subjects (nine or 36% vs one or 4%), and this was also true on the
ST-T ISOI maps (14 or 56% vs one or 4%). No correlation was found between
the major abnormalities on body surface maps and syncopal episodes.
However, the high prevalence (76%) of these alterations among the patients
with LQTS and their infrequent occurrence in the control population
strongly suggests that they may be useful markers for the diagnosis of
atypical cases. The prominent electronegative area on the anterior thorax
can be related to delayed repolarization of a portion of the anterior wall
of the heart. This finding is in agreement with the hypothesis that lower
than normal right cardiac sympathetic activity is the main pathogenetic
mechanism of LQTS. Multipeak distribution and high nondipolar content
suggest regional electrical disparities in the ventricular recovery
process. This may in part account for the high susceptibility of patients
with LQTS to malignant arrhythmias.
ARTICLES
Mapping of body surface potentials in patients with the idiopathic long QT syndrome
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