Implantable defibrillator electrograms and origin of left ventricular impulses: an analysis of regionalization ability and visual spatial resolution
| Autor: | Jesús, Almendral, Felipe, Atienza, Estrella, Everss, Loreto, Castilla, Esteban, Gonzalez-Torrecilla, José, Ormaetxe, Angel, Arenal, Mercedes, Ortiz, Margarita, Sanromán-Junquera, Inmaculada, Mora-Jiménez, José M, Bellon, José L, Rojo |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Heart Ventricles Cardiac Pacing Artificial Electric Countershock Discriminant Analysis Signal Processing Computer-Assisted Equipment Design Middle Aged Ventricular Function Left Defibrillators Implantable Logistic Models Predictive Value of Tests Spain Tachycardia Ventricular Humans Female Prospective Studies Electrophysiologic Techniques Cardiac |
| Zdroj: | Journal of cardiovascular electrophysiology. 23(5) |
| ISSN: | 1540-8167 |
| Popis: | The implantable cardioverter-defibrillator (ICD) electrogram (EG) is a documentation of ventricular tachycardia. We prospectively analyzed EGs from ICD electrodes located at the right ventricle apex to establish (1) ability to regionalize origin of left ventricle (LV) impulses, and (2) spatial resolution to distinguish between paced sites.LV electro-anatomic maps were generated in 15 patients. ICD-EGs were recorded during pacing from 22 ± 10 LV sites. Voltage of far-field EG deflections (initial, peak, final) and time intervals between far-field and bipolar EGs were measured. Blinded visual analysis was used for spatial resolution. Initial deflections were more negative and initial/peak ratios were larger for lateral versus septal and superior versus inferior sites. Time intervals were shorter for apical versus basal and septal versus lateral sites. Best predictive cutoff values were voltage of initial deflection-1.24 mV, and initial/peak ratio0.45 for a lateral site, voltage of final deflection-0.30 for an inferior site, and time interval80 milliseconds for an apical site. In a subsequent group of 9 patients, these values predicted correctly paced site location in 54-75% and tachycardia exit site in 60-100%. Recognition of paced sites as different by EG inspection was 91% accurate. Sensitivity increased with distance (0.96 if ≥ 2 cm vs 0.84 if2 cm, P0.001) and with presence of low-voltage tissue between sites (0.94 vs 0.88, P0.001).Standard ICD-EG analysis can help regionalize LV sites of impulse formation. It can accurately distinguish between 2 sites of impulse formation if they are ≥2 cm apart. |
| Databáze: | OpenAIRE |
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