title: Transmural mapping of myocardial refractoriness and endocardial dispersion of repolarization in an ovine model of chronic myocardial infarction.
abstract: BACKGROUND
  Myocardial refractoriness and repolarization is an important electrophysiological property that, when altered, increases the risk of arrhythmogenesis. These electrophysiological changes associated with chronic myocardial infarction (MI) have not been studied in detail. We assessed the influence of left ventricular (LV) scarring on local refractoriness, repolarization, and electrogram characteristics.
  
  
  METHODS
  MI was induced in five sheep by percutaneous left anterior descending artery occlusion for 3 hours. Mapping was performed at 19 +/- 6 weeks post-MI. A total of 20 quadripolar transmural needles were deployed at thoracotomy in the LV within and surrounding scar. Bipolar pacing was performed from each needle to assess the effective refractory period (ERP) of the subendocardium and subepicardium. The activation (AT) and repolarization (RT) times, and modified activation recovery interval (ARI(m)) were determined from endocardial unipolar electrograms recorded in sinus rhythm simultaneously from all needles. Scarring was quantified histologically and compared with electrophysiological characteristics.
  
  
  RESULTS
  Increased scarring corresponded with increased ERP (P < 0.01), decreased subendocardial electrogram amplitude (P < 0.001), and slope (P < 0.001). ERP did not differ between endocardium and epicardium (P > 0.05). The ARI(m) and RT were prolonged during early myocardial activation (P < 0.001). After adjusting for AT, the RT and ARI(m) were prolonged in areas of scarring (P < 0.001). After adjusting for electrogram amplitude, the ARI(m) was prolonged in dense scar (P < 0.05).
  
  
  CONCLUSIONS
  We confirmed histologically that scarring contributes to prolongation of repolarization, increased refractoriness, and reductions in conduction and voltage post-MI. Prolongation of repolarization may be further augmented when local activation is earliest or electrogram voltage is decreased within scar.
authors: Department of Cardiology, Westmead Hospital, Sydney, Australia. jimp@westgate.wh.usyd.edu.au
authors: Jim
authors: J
authors: Pouliopoulos
authors: Aravinda
authors: A
authors: Thiagalingam
authors: Vicki E
authors: VE
authors: Eipper
authors: Craig
authors: C
authors: Campbell
authors: David L
authors: DL
authors: Ross
authors: Pramesh
authors: P
authors: Kovoor
mesh_terms: D000818:Animals; D018780:Body Surface Potential Mapping / Q000379:methods*; D002908:Chronic Disease; D004195:Disease Models, Animal; D004699:Endocardium / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D012756:Sheep; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*