The Electrophysiological Cardiac Ventricular Substrate in Patients After Myocardial Infarction: Noninvasive Characterization With Electrocardiographic Imaging

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• 作者：Phillip S.  ; Cuculich MD^?/sup> ;   ; ^&dagger ; ; Junjie  ; Zhang MS^?/sup> ; Yong  ; Wang PhD^?/sup> ; Kavit A.  ; Desouza MD^?/sup> ; Ramya  ; Vijayakumar MS^?/sup> ; Pamela K.  ; Woodard MD^&Dagger ; ; Yoram  ; Rudy PhD^?/sup> ;   ; ^&dagger ; ;   ; ^&Dagger ; ;   ; ^{rudy@wustl.edu}
• 关键词：border zone ; ECGI ; infarct ; noninvasive imaging ; ventricular substrate
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：25 October 2011
• 年：2011
• 卷：58
• 期：18
• 页码：1893-1902
• 全文大小：4269 K

文摘

Objectives

The aim of this study was to noninvasively image the electrophysiological (EP) substrate of human ventricles after myocardial infarction and define its characteristics.

Background

Ventricular infarct border zone is characterized by abnormal cellular electrophysiology and altered structural architecture and is a key contributor to arrhythmogenesis. The ability to noninvasively image its electrical characteristics could contribute to understanding of mechanisms and to risk-stratification for ventricular arrhythmia.

Methods

Electrocardiographic imaging, a noninvasive functional EP imaging modality, was performed during sinus rhythm (SR) in 24 subjects with infarct-related myocardial scar. The abnormal EP substrate on the epicardial aspect of the scar was identified, and its location, size, and morphology were compared with the anatomic scar imaged by other noninvasive modalities.

Results

Electrocardiographic imaging constructs epicardial electrograms that have characteristics of reduced amplitude (low voltage) and fractionation. Electrocardiographic imaging colocalizes the epicardial electrical scar to the anatomic scar with a high degree of accuracy (sensitivity 89 % , specificity 85 % ). In nearly all subjects, SR activation patterns were affected by the presence of myocardial scar. Late potentials could be identified and were almost always within ventricular scar.

Conclusions

Electrocardiographic imaging accurately identifies areas of anatomic scar and complements standard anatomic imaging by providing scar-related EP characteristics of low voltages, altered SR activation, electrogram fragmentation, and presence of late potentials.