Epicardial leads in man

Jouve, A; Corriol, J; Torresani, J; Benyamine, R; Velasque, P; R, Peytavy

doi:10.1016/0002-8703(60)90409-9

Cited by 29 publications

(11 citation statements)

References 19 publications

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“…2B, 4) also shows rS morphology. Thus, anterior-paraseptal, apical, posterior, and superior RV epicardium always exhibit waveforms that are amplitude variations of RS or rSrЈ morphology, in agreement with intraoperative mapping in humans (5,6).…”

Section: Resultssupporting

confidence: 78%

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Activation and repolarization of the normal human heart under complete physiological conditions

Ramanathan

Jia

Ghanem

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

229

166

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Knowledge of normal human cardiac excitation stems from isolated heart or intraoperative mapping studies under nonphysiological conditions. Here, we use a noninvasive imaging modality (electrocardiographic imaging) to study normal activation and repolarization in intact unanesthetized healthy adults under complete physiological conditions. Epicardial potentials, electrograms, and isochrones were noninvasively reconstructed. The normal electrophysiological sequence during activation and repolarization was imaged in seven healthy subjects (four males and three females). Electrocardiographic imaging depicted salient features of normal ventricular activation, including timing and location of the earliest right ventricular (RV) epicardial breakthrough in the anterior paraseptal region, subsequent RV and left ventricular (LV) breakthroughs, apex-to-base activation of posterior LV, and late activation of LV base or RV outflow tract. The repolarization sequence was unaffected by the activation sequence, supporting the hypothesis that in normal hearts, local action potential duration (APD) determines local repolarization time. Mean activation recovery interval (ARI), reflecting local APD, was in the typical human APD range (235 ms). Mean LV apex-to-base ARI dispersion was 42 ms. Average LV ARI exceeded RV ARI by 32 ms. Atrial images showed activation spreading from the sinus node to the rest of the atria, ending at the left atrial appendage. This study provides previously undescribed characterization of human cardiac activation and repolarization under normal physiological conditions. A common sequence of activation was identified, with interindividual differences in specific patterns. The repolarization sequence was determined by local repolarization properties rather than by the activation sequence, and significant dispersion of repolarization was observed between RV and LV and from apex to base.noninvasive electrocardiographic imaging ͉ normal cardiac activation and repolarization ͉ normal sinus rhythm U nderstanding normal cardiac excitation provides a necessary baseline for understanding abnormal cardiac electrical activity and rhythm disorders of the heart, a major cause of death and disability. So far, knowledge of normal human cardiac excitation has been obtained mostly through extrapolation from animal studies, including canine (1, 2) and chimpanzee (3). In addition, human data have been obtained from intraoperative epicardial mapping (4-7) and isolated human hearts (8). Extrapolation of animal studies to humans is limited by interspecies differences in anatomy and electrophysiology. Also, the animal and human studies were conducted under nonphysiological conditions (e.g., anesthesia effects and heart exposure during intraoperative mapping; effects of isolation and absence of neural inputs, mechanical loading, and normal perfusion in isolated heart studies). Until now, it has not been possible to study cardiac excitation in intact healthy subjects under normal physiological conditions because of the unavailabili...

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Section: Resultssupporting

confidence: 78%

“…1 as a representative example. Electrograms are shown from select RV and LV locations ( (8,18) and RV free-wall activation, the sharp rS downslope reflects local epicardial RV activation, and the rest of the S wave reflects continued RV activation and remote LV activation (5,6). Toward RV apex (Fig.…”

Section: Resultsmentioning

confidence: 99%

Activation and repolarization of the normal human heart under complete physiological conditions

Ramanathan

Jia

Ghanem

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

229

166

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“…9, 10, 12 the lateral half of the anterior surface and lateral surface,11 and the upper portion of the left border. 8 It should be emphasized that small are as of early epicardial activation can easily be missed when only a limited number of locations is explored. This is also apparent in our study: In the two hearts where recordings from only about 50 epicardial sites have been made ( fig.…”

Section: Epicardial Excitationmentioning

confidence: 99%

Total Excitation of the Isolated Human Heart

et al. 1970

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SUMMARYTo obtain information conceming the time course and instantaneous distribution of the excitatory process of the normal human healt, studies were made on isolated human hearts from seven individuals who died from various cerebral conditions, but who had no history of cardiac disease. Measurements were made from as many as 870 intramural terminals.In the isolated human hearts three endocardial areas were synchronously excited o to 5 msec after the start of the left ventricular activity potential. These areas increased rapidly in si ze dUl'ing the next 5 to 10 msec and became confluent in 15 to 20 msec. The left ventricular areas Rrst excited were (1) high on the anterior paraseptal wall just below the attachment of the mitral valve; (2) central on the left surface of the interventricular septum and (3) posterior paraseptal about one third of the distance from apex to base. The last part of the left ventricle to be activated usually was the posterobasal area. Endocardial activation of the right ventricle was found to start ne ar the insertion of the anterior papillary muscle 5 to 10 msec af ter onset of the left ventricular cavity potential. Septal activation started in the micldle third of the left side of the interventricular septurn, somewhat anteriorly, and at the lower third at the junction of the septum and posterior wall. The epicardial excitation pattem reflected the movements of the intramural excitation wave. Conduction velo city was determined in one heart by an appropriate stimulation technic. Atrial excitation, explored in two hearts, spread more or less according to concentric isochronic lines. Control studies, carried out on Rve canine hearts, disclosed that the pattem of ventricular excitation did not change af ter isolation and perfusion. However, total excitation was completed earlier in the isolated heart, and conduction velo city increased.Careful mapping illustrations are presented.Additional Indexing W ords:Ventricular excitation Intramural conduction velo city Epicardial excitation Atrial excitation K NOWLEDGE of the time course and instantaneous distribution of the excitatory pro ce ss of the normal human heart would be of value for an understanding of the QRS complex.Studies of this process during surgical intervention for heart disease or pulmonary

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“…Sporadic observations have been made in the human heart under a variety of surgical conditions in the last 50 years, relating mostly to unipolar QRS morphology. [8][9][10][11][12][13] In 1970, Durrer et al described the epicardial and intramural activation sequence in seven extirpated, reperfused human hearts. '4 The activation of the human heart was found to be different in several ways from the dog heart.…”

mentioning

confidence: 99%

Epicardial activation of the intact human heart without conduction defect.

Wyndham¹,

Meeran²,

Smith³

et al. 1979

Circulation

111

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SUMMARY To describe the epicardial ventricular activation sequence in the intact human heart, we obtained epicardial maps from 11 patients with normal QRS undergoing open heart surgery. Epicardial breakthrough (EBT), defined as the emergence of a radially propagating epicardial wavefront, occurred in three to five sites in each patient, and was earliest in the anterior right ventricle, 7-25 msec (mean 17 msec) after the onset of the QRS in all patients. Subsequent EBT occurred in the inferior right ventricle (10 sites in 10 patients), in the anterolateral left ventricle (13 sites in 10 patients), and the inferior left ventricle (eight sites in seven patients). Latest epicardial activation (LEA), defined as the latest site of recordable epicardial activity, occurred in the basal segments in all patients, anteriorly in the right ventricle in five patients, and inferiorly in six patients, four on the right and two on the left. LEA occurred 63-96 msec (mean 77 msec) after the onset of the QRS, and was recorded within 20 msec of the end of the QRS in all patients. Sequence of epicardial activation reflected a fusion process among the wavefronts. This descriptive and quantitative data should provide a suitable basis for comparison of abnormal ventricular activation sequences in patients undergoing surgery for preexcitation or ventricular tachycardia.MOST DESCRIPTIONS of ventricular activation in the mammalian heart are derived from canine experimentation using epicardial and multiple intramyocardial electrodes.'" Sporadic observations have been made in the human heart under a variety of surgical conditions in the last 50 years, relating mostly to unipolar QRS morphology.8-13 In 1970, Durrer et al. described the epicardial and intramural activation sequence in seven extirpated, reperfused human hearts.'4 The activation of the human heart was found to be different in several ways from the dog heart.Extensive epicardial mapping of the intact human heart has become feasible, as a result of the experience gained with mapping of patients with cardiac arrhythmias. In this study, we systematically report observations of epicardial activation in the intact human heart, describing and quantitating the range of normality in epicardial activation sequence in 11 patients undergoing open heart surgery. Material and Methods Patient SelectionWe reviewed ECGs of patients scheduled for open heart surgery at

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Epicardial leads in man

Cited by 29 publications

References 19 publications

Activation and repolarization of the normal human heart under complete physiological conditions

Activation and repolarization of the normal human heart under complete physiological conditions

Total Excitation of the Isolated Human Heart

Epicardial activation of the intact human heart without conduction defect.

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