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Body Surface Mapping of T-wave Alternans Depends on the Distribution of Myocardial Scarring.

Zeller A, Ghoraani B - Open Cardiovasc Med J (2015)

Bottom Line: Cardiac scarring with different sizes were simulated by manipulating the apparent velocity, transmembrane potential and transition zone at varied locations along the left ventricular posterior wall.The TWA amplitude generally increased with the increment of scar size (P<0.00001).We found one specific location (a non-standard lead) that consistently appeared as the top five maximum TWA leads and could be considered as an additional lead to improve the outcome of the TWA testing in cardiomyopathy patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.

ABSTRACT
T-Wave alternans (TWA) testing using 12-lead electrocardiogram/Frank leads is emerging as an important non-invasive biomarker to identify patients at high risk of Sudden Cardiac Death (SCD). Cardiac scarring is very common among cardiomyopathy patients; however, its influence on the body surface distribution of TWA has not yet been defined. Our objective was to perform a simulation study in order to determine whether cardiac scarring affects the distribution of TWA on thorax such that the standard leads fail to detect TWA in some of cardiomyopathy patients; thereby producing a false-negative test. Developing such a novel lead configuration could improve TWA quantification and potentially optimize electrocardiogram (ECG) lead configuration and risk stratification of SCD in cardiomyopathy patients. The simulation was performed in a 1500-node heart model using ECGSIM. TWA was mimicked by simulating action potential duration alternans in the ventricles. Cardiac scarring with different sizes were simulated by manipulating the apparent velocity, transmembrane potential and transition zone at varied locations along the left ventricular posterior wall. Our simulation study showed that the location of maximum TWA depends on the location and size of the myocardium scarring in patients with cardiomyopathy, which can give rise to false-negative TWA signal detection using standard clinical leads. The TWA amplitude generally increased with the increment of scar size (P<0.00001). We found one specific location (a non-standard lead) that consistently appeared as the top five maximum TWA leads and could be considered as an additional lead to improve the outcome of the TWA testing in cardiomyopathy patients.

No MeSH data available.


Related in: MedlinePlus

The black square electrodes represent the standard leads. The blue, red and green electrodes represent the maximum TWA location for each type of APDA. TWAmaxplacement on the thorax with no scarring and two different scar size and placement.
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Figure 8: The black square electrodes represent the standard leads. The blue, red and green electrodes represent the maximum TWA location for each type of APDA. TWAmaxplacement on the thorax with no scarring and two different scar size and placement.

Mentions: The location of TWAmax when there is no scarring occurs on standard electrode, V3 (Fig. 8A).


Body Surface Mapping of T-wave Alternans Depends on the Distribution of Myocardial Scarring.

Zeller A, Ghoraani B - Open Cardiovasc Med J (2015)

The black square electrodes represent the standard leads. The blue, red and green electrodes represent the maximum TWA location for each type of APDA. TWAmaxplacement on the thorax with no scarring and two different scar size and placement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4378024&req=5

Figure 8: The black square electrodes represent the standard leads. The blue, red and green electrodes represent the maximum TWA location for each type of APDA. TWAmaxplacement on the thorax with no scarring and two different scar size and placement.
Mentions: The location of TWAmax when there is no scarring occurs on standard electrode, V3 (Fig. 8A).

Bottom Line: Cardiac scarring with different sizes were simulated by manipulating the apparent velocity, transmembrane potential and transition zone at varied locations along the left ventricular posterior wall.The TWA amplitude generally increased with the increment of scar size (P<0.00001).We found one specific location (a non-standard lead) that consistently appeared as the top five maximum TWA leads and could be considered as an additional lead to improve the outcome of the TWA testing in cardiomyopathy patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.

ABSTRACT
T-Wave alternans (TWA) testing using 12-lead electrocardiogram/Frank leads is emerging as an important non-invasive biomarker to identify patients at high risk of Sudden Cardiac Death (SCD). Cardiac scarring is very common among cardiomyopathy patients; however, its influence on the body surface distribution of TWA has not yet been defined. Our objective was to perform a simulation study in order to determine whether cardiac scarring affects the distribution of TWA on thorax such that the standard leads fail to detect TWA in some of cardiomyopathy patients; thereby producing a false-negative test. Developing such a novel lead configuration could improve TWA quantification and potentially optimize electrocardiogram (ECG) lead configuration and risk stratification of SCD in cardiomyopathy patients. The simulation was performed in a 1500-node heart model using ECGSIM. TWA was mimicked by simulating action potential duration alternans in the ventricles. Cardiac scarring with different sizes were simulated by manipulating the apparent velocity, transmembrane potential and transition zone at varied locations along the left ventricular posterior wall. Our simulation study showed that the location of maximum TWA depends on the location and size of the myocardium scarring in patients with cardiomyopathy, which can give rise to false-negative TWA signal detection using standard clinical leads. The TWA amplitude generally increased with the increment of scar size (P<0.00001). We found one specific location (a non-standard lead) that consistently appeared as the top five maximum TWA leads and could be considered as an additional lead to improve the outcome of the TWA testing in cardiomyopathy patients.

No MeSH data available.


Related in: MedlinePlus