Study of the sequence of ventricular activation and the QRS complex of the pathologic human heart, using direct epicardial leads

Barbato, E; Fujioka, Terutaka; Debes, Antonio Carlos; Pileggi, F; Filho, Celestino Bourroul; Silva, Paulo de Paula e; Décourt, Luiz V.

doi:10.1016/0002-8703(58)90274-6

Cited by 16 publications

(3 citation statements)

References 14 publications

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“…Forty-two sites were identified. Earliest epicardial breakthrough in the 11 patients was in the anterior right ventricular wall adjacent to the septum. We observed subsequent breakthrough sites in all patients.…”

Section: Patient Selectionmentioning

confidence: 98%

“…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%

“…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.…”

mentioning

confidence: 99%

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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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Section: Patient Selectionmentioning

confidence: 98%

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confidence: 99%