Investigation of pacing site-related changes in global restitution dynamics by non-contact mapping.
OBJECTIVE
The determination of dynamic changes in ventricular repolarization may provide insight into arrhythmogenic mechanisms as a consequence of pacing site. This study investigated acute pacing site effects on global characteristics of electrical restitution using high resolution, non-contact mapping (NCM).


RESULTS
Activation-recovery intervals (ARIs) were determined from reconstructed left ventricular electrograms by the NCM system and were analysed during pacing from the right atrial appendage (RAA, intrinsic), right ventricular apex (RVA), and right ventricular septum (RVS) with extrasystoles delivered at intermediate and short coupling intervals in anesthetized swine (n = 5). Electrical restitution curves were determined by the S1-S2 pacing protocol. Activation-recovery interval restitution slopes were determined by the overlapping linear segments regression method. Global distribution of repolarization was defined as the coefficient of variation of the ARIs during restitution. The maximum ARI slopes yielded by RVA pacing were significantly greater than RAA pacing (0.44 vs. 0.32; P < 0.05) and RVS pacing (0.44 vs. 0.37; P = 0.05). There was no significant difference between RAA and RVS pacing (0.32 vs. 0.37). The global distribution of ARIs during restitution from RVA pacing was significantly greater than RAA pacing (12.0 vs. 8.1%; P < 0.05).


CONCLUSIONS
Right ventricular apex pacing is associated with impaired global repolarization patterns compared to RAA and RVS. These observations support the hypothesis that RVA pacing may be associated with increased risk of ventricular arrhythmias compared to RVS pacing.
Ahlberg
Sarah E
SE
Cardio Vascular, Medtronic Inc., 7601 Northland Drive, Brooklyn Park, MN 55428, USA.
Yue
Arthur M
AM
Skadsberg
Nicholas D
ND
Roberts
Paul R
PR
Iaizzo
Paul A
PA
Morgan
John M
JM
D000818:Animals; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004195:Disease Models, Animal; D004562:Electrocardiography; D006325:Heart Atria / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D010138:Pacemaker, Artificial; D012307:Risk Factors; D013552:Swine