Noninvasive ECG imaging of electrophysiologically abnormal substrates in infarcted hearts - A model study
Noninvasive ECG imaging of electrophysiologically abnormal substrates in infarcted hearts - A model study
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DOI：
10.1161/01.cir.101.5.533
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发表时间：
2000-02-08
期刊：
影响因子：
37.8
通讯作者：
Rudy, Y
中科院分区：
文献类型：
--
作者：
Burnes, JE;Taccardi, B;Rudy, Y
背景-心肌梗死和随后的重构产生了具有改变的电生理（EP）特性的底物，这些底物具有高度致心律失常性。现有的ECG方法不能总是检测到这些底物的存在，也不能提供关于其EP特征的任何详细信息。迫切需要一种具有这种能力的非侵入性方法来识别有心律失常风险的患者以及指导和评估治疗。最近，我们开发了一种无创的心电图成像模式，可以重建心外膜EP信息从体表电位。我们将其应用扩展到心脏结构性疾病，并检查其检测和表征异常EP substrates.Methods和Results-Epicardial potential的能力，记录了490电极袜子从开胸犬。从正常心脏和从左前降支冠状动脉闭塞和乙醇注射以产生梗塞后2小时的同一心脏获得记录。在人体躯干模型中，从这些心外膜电位生成体表电位。真实的几何误差和测量噪声被添加到躯干数据中，然后用于无创重建心外膜电位和电描记图（EGM），具有极高的准确性。重建了与梗死基底相关的EP特征，包括（1）梗死上方的负向区，（2）以负向为主的大面积EGM，（例如，Q波EGM），（3）叠加RS偏转的Q波EGM，反映梗死边缘区内存活心肌的局部激活，（4）EGM负导数的幅度降低，（5）梗死区心电图QRS积分为负。结论心电图成像可无创性地检测和定位与梗死和结构性心脏病相关的异常EP底物。
Background-Myocardial infarction and subsequent remodeling create substrates with altered electrophysiological (EP) properties that are highly arrhythmogenic. Existing ECG methods cannot always detect the existence of such substrates nor provide any detailed information about their EP characteristics. A noninvasive method with such capabilities is greatly needed for identifying patients at risk of arrhythmias and for guidance and evaluation of therapy. Recently, we developed a noninvasive ECG imaging modality that can reconstruct epicardial EP information from body surface potentials. We extended its application to hearts with structural disease and examined its ability to detect and characterize abnormal EP substrates.Methods and Results-Epicardial potentials were recorded with a 490-electrode sock from an open-chest dog. Recordings were obtained from a normal heart and from the same heart 2 hours after left anterior descending coronary artery occlusion and ethanol injection to create an infarct. Body surface potentials were generated from these epicardial potentials in a human torso model. Realistic geometry errors and measurement noise were added to the torso data, which were then used to noninvasively reconstruct epicardial potentials and electrograms (EGMs), with excellent accuracy. EP characteristics associated with the infarct substrate were reconstructed, including (1) a negative region over the infarct, (2) EGMs with large predominant negative deflections (eg, Q-wave EGMs), (3) Q-wave EGMs with superimposed RS deflections reflecting local activation of surviving myocardium within the infarct border zone, (4) reduced magnitudes of EGM negative derivatives, and (5) negative QRS integrals of EGMs over the infarct.Conclusions-ECG imaging can noninvasively detect and map abnormal EP substrates associated with infarction and structural heart disease.