Circulation, Vol 86, 467-474, Copyright © 1992 by American Heart Association
RC Saumarez, AJ Camm, A Panagos, JS Gill, JT Stewart, MA de Belder, IA Simpson and WJ McKenna
BACKGROUND. Intraventricular conduction in hypertrophic cardiomyopathy
(HCM) has been characterized to test the hypothesis that myofibrillar
disarray will cause dispersion of activation throughout the ventricular
myocardium. METHODS AND RESULTS. Of 37 patients with HCM, four had
spontaneous ventricular fibrillation (VF), five had nonsustained
ventricular tachycardia (VT), 13 had no risk factors, and 15 had a family
history of sudden death. These patients and four controls were studied by
pacing one site in the right ventricle and recording electrograms from
three other right ventricular sites. These electrograms were high-pass
filtered to emphasize small deflections due to activation of small bundles
of myocytes close to the electrode. Intraventricular conduction curves were
obtained with S1S2 coupling intervals decreasing in 1-msec steps from 479
msec to ventricular effective refractory period (VERP). These curves were
repeated by pacing each RV site in turn and were characterized by two
parameters: the point at which latency increased by 0.75 msec/20 msec
reduction of the S1S2 coupling interval and an increase in electrogram
duration between an S1S2 of 350 msec and VERP. Patients with VF, VT, and
family history of sudden death had a mean increase in electrogram duration
of 12.8 (2.9-32.3) msec versus 4.6 (-4.2 to 14.0) msec in low-risk patients
and controls. Electrogram latency increased at an S1S2 of 363 msec in the
VF group (342-386), 269 msec in the controls (266-279), and 326 msec in the
non-VF group (260-399). Discriminant analysis separated VF patients from
the remainder (p less than 0.0001) and VF, VT, and family history of sudden
death patients from the low-risk and control groups (p less than 10(-6)).
CONCLUSIONS. Patients with HCM who are at risk of sudden death have
increased dispersion and inhomogeneity of intraventricular conduction, and
this may create the conditions for reentry and arrhythmogenesis.
ARTICLES
Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms
Department of Cardiological Sciences, St. George's Hospital Medical School, London, UK.
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