Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy

Peng-Sheng Chen, Kenneth M. Moser, Walter P. Dembitsky, William R. Auger, Pat O. Daily, Constance M. Calisi, Stuart W. Jamieson, Gregory K. Feld

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

To map global epicardial repolarization patterns and test the "SI" model of T wave generation, the patterns of epicardial activation and repolarization in patients with chronic pulmonary thromboembolism and right ventricular hypertrophy were studied by computerized mapping techniques and monophasic action potential (MAP) recordings. The ventricular activation patterns were characterized by delayed right ventricular activation and the absence of normal early epicardial ventricular breakthrough in some cases. The repolarization patterns were characterized by nonuniform distribution of T wave morphologies. The T waves were predominantly positive over the left ventricular epicardium and negative or biphasic over the right ventricular epicardium. The activation-recovery (A-R) intervals were, measured from the local activation to the maximal dV/dt of the upstroke of the T waves (Wyatt method). The difference between the A-R intervals and the MAP from onset of activation to 90% repolarization (MAP90) varies according to T wave morphology and could be as high as 96 msec with positive T waves, despite significant correlations (r=0.56-0.90) between MAP90 and A-R intervals for each morphology. Better overall correlations were found if the minimal dV/dt on the downslope of the positive T waves was chosen to estimate the time of local repolarization (alternative method). Using this method, the mean A-R intervals were the same over the right and left ventricles. Cardiopulmonary bypass significantly prolonged the action potential duration equally at all parts of the epicardium. We conclude that in patients with right ventricular hypertrophy, the time of local repolarization can best be estimated by our alternative method; the right ventricle completes activation and repolarization later than the left ventricle, and the distribution of T wave morphologies is nonuniform, with predominantly positive T waves observed over the left ventricle and negative or biphasic T waves observed over the right ventricle. These findings are compatible with the SI model of the generation of T waves.

Original languageEnglish (US)
Pages (from-to)104-118
Number of pages15
JournalCirculation
Volume83
Issue number1
StatePublished - 1991
Externally publishedYes

Fingerprint

Right Ventricular Hypertrophy
Patient Rights
Heart Ventricles
Pericardium
Action Potentials
Cardiopulmonary Bypass
Pulmonary Embolism

Keywords

  • Cardiopulmonary bypass
  • Monophasic action potential
  • Si model
  • T waves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Chen, P-S., Moser, K. M., Dembitsky, W. P., Auger, W. R., Daily, P. O., Calisi, C. M., ... Feld, G. K. (1991). Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy. Circulation, 83(1), 104-118.

Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy. / Chen, Peng-Sheng; Moser, Kenneth M.; Dembitsky, Walter P.; Auger, William R.; Daily, Pat O.; Calisi, Constance M.; Jamieson, Stuart W.; Feld, Gregory K.

In: Circulation, Vol. 83, No. 1, 1991, p. 104-118.

Research output: Contribution to journalArticle

Chen, P-S, Moser, KM, Dembitsky, WP, Auger, WR, Daily, PO, Calisi, CM, Jamieson, SW & Feld, GK 1991, 'Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy', Circulation, vol. 83, no. 1, pp. 104-118.
Chen P-S, Moser KM, Dembitsky WP, Auger WR, Daily PO, Calisi CM et al. Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy. Circulation. 1991;83(1):104-118.
Chen, Peng-Sheng ; Moser, Kenneth M. ; Dembitsky, Walter P. ; Auger, William R. ; Daily, Pat O. ; Calisi, Constance M. ; Jamieson, Stuart W. ; Feld, Gregory K. / Epicardial activation and repolarization patterns in patients with right ventricular hypertrophy. In: Circulation. 1991 ; Vol. 83, No. 1. pp. 104-118.
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