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• W4377015768 abstract "Microvolt QRS alternans on the surface ECG, induced with rapid ventricular pacing, has been reported by our group to predict ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM). The presence of intracardiac depolarization alternans and its relation to VT has not been defined. To characterize the spatial distribution of depolarization alternans in patients with ICM, and its relationship to the diastolic VT pathway. Intraoperative VT mapping was performed in 9 patients with ICM and VT. Bipolar electrograms (EGM) at high gain (x20000, resolution 50uV) were recorded from endocardial and epicardial sites using a balloon array and sock respectively (112 bipoles each), during paced drive trains and induced VT. For each bipolar EGM during the drive train, the presence of intra-QRS (within surface ECG QRS) and post-QRS alternans was determined by manual inspection based on alternating EGM amplitude and/or morphology. Alternans magnitude was computed as the maximum difference between the mean even and odd beat of the drive train. Activation mapping localized the VT circuit and diastolic path. The entrance/exit zone to the diastolic path was defined as the region within one bipolar spacing in any direction of the entrance/exit site. All regions >1 bipole spacing from the diastolic pathway were considered remote. All patients had inducible VT and their diastolic paths localized to the endocardium. Alternans was present in 8/9 patients and observed in 101/930 (11%) endocardial bipolar EGMs (11±13 per patient). Among alternans sites, intra-QRS alternans was as frequent as post-QRS alternans (54±36% vs 61±29%, p=0.78). Intra-QRS alternans was more common at the VT entrance zone than the diastolic path (14.3 vs 0.0%, p=0.02) or VT exit zone (14.3 vs 0.0%, p=0.07). Intra-QRS alternans was more frequently observed at the VT entrance zone compared to remote regions (14.3 vs 4.6%, p=0.046) and the magnitude of alternans trended towards being larger (4.1 vs 0.5μV, p=0.17). In contrast, there was no difference in either the prevalence (0.0 vs 4.6%, p=0.5) nor the magnitude (0.0 vs 0.5μV, p=0.87) of intra-QRS alternans at the exit zone (Table and Figure). Microvolt intra-QRS endocardial alternans occurs more frequently at the entrance zone of the diastolic pathway in patients with ICM and VT. We suggest this may reflect heterogeneous regions of conduction block which allow vulnerability to VT initiation and be responsible for microvolt QRS alternans on the ECG.Tabled 1Intra-QRS AlternansPost-QRS AlternansDiastolic Path RegionsRemote Regionp-value (paired)Diastolic Path RegionsRemote Regionp-value (paired)Diastolic Path Entrance Alternans Sites, %14.3 (0.0-100.0)4.6 (0.0-13.3)0.0460.0 (0.0-87.5)1.5 (0.0-21.7)0.176Diastolic Path Alternans Sites, %0.0 (0.0-60.0)0.9170.0 (0.0-30.0)1Diastolic Path Exit Alternans Sites, %0.0 (0.0-50.0)0.4990.0 (0.0-42.9)0.575Diastolic Path Entrance Alternans Magnitude, μV4.1 (0.0-344.2)0.5 (0.0-39.9)0.1730.0 (0.0-449.1)6.7 (0-153.3)0.237Diastolic Path Alternans Magnitude, μV0.0 (0.0-117.1)0.60.0 (0.0-346.9)0.612Diastolic Path Exit Alternans Magnitude, μV0.0 (0.0-114.8)0.8660.0 (0.0-433)0.575Data expressed as median (minimum - maximum). Open table in a new tab" @default.
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• W4377015768 date "2023-05-01" @default.
• W4377015768 modified "2023-10-17" @default.
• W4377015768 title "CE-452773-2 MICROVOLT INTRA-QRS ALTERNANS IDENTIFIES THE ENTRANCE SITES OF MONOMORPHIC VENTRICULAR TACHYCARDIA IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY: INSIGHTS FROM HIGH-RESOLUTION INTRAOPERATIVE MAPPING" @default.
• W4377015768 doi "https://doi.org/10.1016/j.hrthm.2023.03.405" @default.
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