Orini, M;
Taggart, P;
Lambiase, PD;
(2018)
In-vivo human sock-mapping validation of a simple model that explains unipolar electrogram morphology in relation to conduction-repolarization dynamics.
Journal of Cardiovascular Electrophysiology
, 29
(7)
pp. 990-997.
10.1111/jce.13606.
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Abstract
INTRODUCTION: The unipolar electrogram (UEG) provides local measures of cardiac activation and repolarization and is an important translational link between patient and laboratory. A simple theoretical model of the UEG was previously proposed and tested in-silico. METHOD AND RESULTS: The aim of this study was to use epicardial sock-mapping data to validate the simple model's predictions of unipolar electrogram morphology in the in-vivo human heart. The simple model conceptualizes the UEG as the difference between a local cardiac action potential and a position-independent component representing remote activity, which is defined as the average of all action potentials. UEGs were recorded in 18 patients using a multi-electrode sock containing 240 electrodes and activation (AT) and repolarization time (RT) were measured using standard definitions. For each cardiac site, a simulated local action potential was generated by adjusting a stylized action potential to fit AT and RT measured in-vivo. The correlation coefficient (cc) measuring the morphological similarity between 13,637 recorded and simulated UEGs was cc = 0.89 (0.72-0.95), median (Q1 -Q3 ), for the entire UEG, cc = 0.90 (0.76-0.95) for QRS complexes, and cc = 0.83 (0.58-0.92) for T-waves. QRS and T-wave areas from recorded and simulated UEGs showed cc > 0.89 and cc > 0.84, respectively, indicating good agreement between voltage isochrones maps. Simulated UEGs accurately reproduced the interaction between AT and QRS morphology and between RT and T-wave morphology observed in-vivo. CONCLUSIONS: Human in-vivo whole heart data support the validity of the simple model, which provides a framework for improving the understanding of the UEG and its clinical utility. This article is protected by copyright. All rights reserved.
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