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Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress

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Title: Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress
Authors: Shun-Shin, MJ
Leong, KMW
Ng, FS
Linton, NWF
Whinnett, ZI
Koa-Wing, M
Qureshi, N
Lefroy, DC
Harding, SE
Lim, PB
Peters, NS
Francis, DP
Varnava, AM
Kanagaratnam, P
Item Type: Journal Article
Abstract: AIMS: Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise. METHODS AND RESULTS: Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50). CONCLUSION: We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.
Issue Date: 28-Feb-2019
Date of Acceptance: 2-Feb-2019
URI: http://hdl.handle.net/10044/1/68694
DOI: https://dx.doi.org/10.1093/europace/euz015
ISSN: 1099-5129
Publisher: Oxford University Press (OUP)
Journal / Book Title: EP-Europace
Copyright Statement: © The Author(s) 2019. Published on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Sponsor/Funder: British Heart Foundation
British Heart Foundation
Daniel Bagshaw Memorial Trust
British Heart Foundation
Funder's Grant Number: PG/15/20/31339
RG/16/3/32175
n/a
FS/14/27/30752
Keywords: Action potential
Electrocardiographical imaging
Rate adaptation
Risk stratification
Spacial conduction heterogeneity
Sudden cardiac death
Ventricular conduction stability
Ventricular fibrillation
Ventricular tachycardia
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status: Published online
Conference Place: England
Embargo Date: 2020-02-28
Online Publication Date: 2019-02-28
Appears in Collections:National Heart and Lung Institute



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