(Circulation. 1999;100:1744-1750.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Electroanatomic Left Ventricular Mapping in the Porcine Model of Healed Anterior Myocardial Infarction
Correlation With Intracardiac Echocardiography and Pathological Analysis
From the Arrhythmia Research Laboratory of the Allegheny University Hospitals, Hahnemann Division, Philadelphia, Pa.
Correspondence to David J. Callans, MD, Hospital of the University of Pennsylvania, Cardiology, 9 Founders Pavilion, 3400 Spruce St, Philadelphia, PA 19104. E-mail callansd{at}mail.med.upenn.edu
Background—Catheter ablation for ventricular tachycardia in healed infarction is limited to patients with inducible, tolerated arrhythmias. Strategies that would allow mapping during sinus rhythm might obviate this limitation.
Methods and Results—Two sets of experiments were performed in
adult pigs to refine a new technique for left ventricular
mapping. First, detailed endocardial maps were done in 5 normal pigs
and 7 pigs 6 to 10 weeks after left anterior descending
coronary artery infarction to characterize electrograms in
normal and infarcted tissue by electroanatomic mapping (CARTO,
Biosense). Electrogram recording sites were verified by
intracardiac echo (ICE, 9 MHz) and grouped by location: infarct (area
of akinesis by ICE), border (0.5-cm perimeter of akinetic area), and
remote. Compared with remote sites, electrograms from infarct sites had
smaller amplitudes (1.2±0.5 versus 5.1±2.1 mV,
P<0.001), longer durations (74.2±26.3 versus 36.3±6.4
ms, P<0.001), and more frequent notched or late
components. Border zone electrograms were intermediate in amplitude and
duration. Second, infarct characterization by electroanatomic mapping
was compared with pathological (exclusion of
triphenyltetrazolium chloride staining) and
ICE measurements. Infarct size by pathology correlated with the area
defined by contiguous electrograms with amplitude 
1 mV
(r=0.98, P=0.0001). Infarct size by ICE
imaging correlated with the area defined by contiguous electrograms
with amplitude 2 mV (r=0.95,
P=0.0016).
Conclusions—Electroanatomic mapping during sinus rhythm allows accurate 3D characterization of infarct architecture and defines the relationship of electrophysiological and anatomic abnormalities. This technique may prove useful in devising anatomically based strategies for ablation of ventricular tachycardia.
Key Words: mapping • myocardial infarction • tachyarrhythmias • electrophysiology
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