From Washington Hospital Center, Washington, DC, and The Bruce Rappaport
Faculty of Medicine, Technion Institute, Haifa, Israel (L.G., S.A.B.).
Correspondence to Martin B. Leon, MD, Washington Cardiology Center, 110 Irving St NW, 4B-1, Washington, DC 20010. E-mail MBL1{at}mhg.edu
Background—A catheter-based left
ventricular (LV) endocardial mapping procedure using
electromagnetic field energy for positioning of the catheter tip was
designed to acquire simultaneous measurements of
endocardial voltage potentials and myocardial
contractility. We investigated such a mapping system to
distinguish between infarcted and normal myocardium in an
animal infarction model and in patients with coronary
artery disease.
Methods and Results—Measurements of LV endocardial unipolar (UP)
and bipolar (BP) voltages and local endocardial shortening were derived
from dogs at baseline (n=12), at 24 hours (n=6), and at 3 weeks (n=6)
after occlusion of the left anterior descending coronary
artery. Also, 12 patients with prior myocardial infarction (MI) and 12
control patients underwent the LV endocardial mapping study for
assessment of electromechanical function in infarcted versus healthy
myocardial regions. In the canine model, a significant decrease in
voltage potentials was noted in the MI zone at 24 hours (UP, 42.8±9.6
to 29.1±12.2 mV, P=0.007; BP, 11.6±2.3 to 4.9±1.2 mV,
P<0.0001) and at 3 weeks (UP, 41.0±8.9 to 13.9±3.9
mV, P<0.0001; BP, 11.2±2.8 to 2.4±0.4 mV,
P<0.0001). No change in voltage was noted in zones
remote from MI. In patients with prior MI, the average voltage was
7.2±2.7 mV (UP)/1.4±0.7 mV (BP) in MI regions, 17.8±4.6 mV
(UP)/4.5±1.1 mV (BP) in healthy zones remote from MI, and 19.7±4.4 mV
(UP)/5.8±1.0 mV (BP) in control patients without prior MI
(P<0.001 for MI values versus remote zones or control
patients). In the canine model and patients, local endocardial
shortening was significantly impaired in MI zones compared with
controls.
Conclusions—These preliminary data suggest that infarcted
myocardium could be accurately diagnosed and distinguished
from healthy myocardium by a reduction in both electrical
voltage and mechanical activity. Such a diagnostic
electromechanical mapping study might be clinically useful for accurate
assessment of myocardial function and viability.
© 1998 American Heart Association, Inc.
Basic Science Reports
Preliminary Animal and Clinical Experiences Using an Electromechanical Endocardial Mapping Procedure to Distinguish Infarcted From Healthy Myocardium
Key Words: endocardium • myocardial infarction • electrophysiology
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