Circulation, Vol 83, 104-118, Copyright © 1991 by American Heart Association
PS Chen, KM Moser, WP Dembitsky, WR Auger, PO Daily, CM Calisi, SW Jamieson and GK Feld
To map global epicardial repolarization patterns and test the "SI" model of
T wave generation, the patterns of epicardial activation and repolarization
in patients with chronic pulmonary thromboembolism and right ventricular
hypertrophy were studied by computerized mapping techniques and monophasic
action potential (MAP) recording. The ventricular activation patterns were
characterized by delayed right ventricular activation and the absence of
normal early epicardial ventricular breakthrough in some cases. The
repolarization patterns were characterized by nonuniform distribution of T
wave morphologies. The T waves were predominantly positive over the left
ventricular epicardium and negative or biphasic over the right ventricular
epicardium. The activation-recovery (A-R) intervals were measured from the
local activation to the maximal dV/dt of the upstroke of the T waves (Wyatt
method). The difference between the A-R intervals and the MAP from onset of
activation to 90% repolarization (MAP90) varies according to T wave
morphology and could be as high as 96 msec with positive T waves, despite
significant correlations (r = 0.56-0.90) between MAP90 and A-R intervals
for each morphology. Better overall correlations were found if the minimal
dV/dt on the downslope of the positive T waves was chosen to estimate the
time of local repolarization (alternative method). Using this method, the
mean A-R intervals were the same over the right and left ventricles.
Cardiopulmonary bypass significantly prolonged the action potential
duration equally at all parts of the epicardium. We conclude that in
patients with right ventricular hypertrophy, the time of local
repolarization can be estimated by our alternative method; the right
ventricle completes activation and repolarization later than the left
ventricle, and the distribution of T wave morphologies is nonuniform, with
predominantly positive T waves observed over the left ventricle and
negative or biphasic T waves observed over the right ventricle. These
findings are compatible with the SI model of the generation of T waves.
ARTICLES
Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy
Division of Cardiology, UCSD Medical Center 92103.
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