Signal characteristics of multichannel epicardial electrograms in chronic ischaemic and scarred myocardium: electromechanical mismatch indicates viability in regions of myocardial dysfunction.
BACKGROUND
To predict the outcome after myocardial revascularisation, a clear separation between hibernation and/or repetitive stunning on the one hand and myocardial scarring on the other hand is of importance.


RESULTS
A total of 44 patients was included in this study. In 35 patients with chronic myocardial ischaemia and an indication for coronary bypass-surgery, epicardial mapping of local activation was performed. Nine patients with LV aneurysm and an indication for antitachycardia surgery were also included. For simultaneous recording of the local electrograms during sinus rhythm, a sock electrode with 102 bipolar leads was used. The regional myocardial contraction pattern was assessed from preoperative angiograms and regional myocardial metabolism (viability) from 18F-FDG PET, respectively. The results were projected on the grid of the intraoperative position of the sock electrode. This enabled regional comparison of electrogram characteristics to local contraction patterns and viability. For the characterisation of local electrograms, peak-to-peak amplitude and duration of activation were calculated using custom-made automated computer-algorithms. Dysfunctional but viable areas showed normal or almost normal electrographic signal characteristics. In contrast, dysfunctional and non-viable myocardium showed a distinct reduction of local amplitudes and prolongation of signal duration. These changes were even more intense in areas of LV aneurysms.


CONCLUSIONS
In patients with chronic ischaemic myocardium, a mismatch between mechanical function and local electrogram characteristics was observed in areas with preserved metabolism. Thus, normal epicardial electrograms in regions of myocardial dysfunction may be an indicator for myocardial viability.
Bruns
H J
HJ
Medizinische Klinik und Poliklinik Innere Medizin C-Kardiologie und Angiologie, Westfälische Wilhelms-Universität Münster, Germany. brunsh@uni-muenster.de
Janssen
F W
FW
Schäfers
M
M
Hammel
D
D
Fetsch
T
T
Arslan
O
O
Krenz
M
M
Vahlhaus
C
C
Borggrefe
M
M
Scheld
H H
HH
Schober
O
O
Breithardt
G
G
Wichter
T
T
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002921:Cicatrix / Q000503:physiopathology*; D004594:Electrophysiology / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology*; D010496:Pericardium / Q000503:physiopathology*