Direct epicardial mapping predicts the recovery of left ventricular dysfunction in chronic ischaemic myocardium.
OBJECTIVE
This study investigated the hypothesis that direct epicardial bipolar mapping is able to predict the recovery of left ventricular (LV) dysfunction in ischaemic myocardium.


RESULTS
In 34 patients with CAD, a maximum of 102 bipolar epicardial electrograms per patient (n=3468 electrograms) were simultaneously recorded with a ventricular jacket array intraoperatively immediately prior to revascularization. Only LV electrograms with good myocardial contact (n=1813, 52+/-14 per patient, mean+/-SD) were analyzed. In accordance to the position of each electrode, segmental myocardial function was assessed by transthoracic echocardiography before and 7+/-2 months (mean+/-SD; range 3-10 months) after CABG using a wall motion score. Preoperatively dysfunctional segments (n=700) were classified as viable (improvement in wall motion score of at least 20% following CABG, n=424) or non-viable (no improvement, n=276). Bipolar voltage was significantly lower in non-viable when compared to viable myocardium (P<0.001, ANOVA) At a cut-off value of 5.9mV, ROC-curve analysis for bipolar voltage (to discriminate between viable and non-viable myocardium) revealed a sensitivity of 83% at a specificity of 83% (area under the ROC-curve of 0.92+/-0.01, mean+/-SE).


CONCLUSIONS
Direct epicardial mapping is able to predict the recovery of chronically ischaemic dysfunctional myocardium and thereby proves the presence of myocardial viability.
Vahlhaus
Christian
C
Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany. Vahlhaus@uni-muenster.de
Bruns
Hans Jürgen
HJ
Stypmann
Jörg
J
Tjan
Tonny D T
TD
Janssen
Frauke
F
Schäfers
Michael
M
Scheld
Hans H
HH
Schober
Otmar
O
Breithardt
Günter
G
Wichter
Thomas
T
D000704:Analysis of Variance; D018780:Body Surface Potential Mapping; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000601:surgery