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Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited

Background: The optimal way to determine repolarization time (RT) from the intracardiac unipolar electrogram (UEG) has been a topic of debate for decades. RT is typically determined by either the Wyatt method or the “alternative method,” which both consider UEG T-wave slope, but differently. Objecti...

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Autores principales: Stoks, Job, Bear, Laura R., Vijgen, Johan, Dendale, Paul, Peeters, Ralf, Volders, Paul G. A., Cluitmans, Matthijs J. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119409/
https://www.ncbi.nlm.nih.gov/pubmed/37089414
http://dx.doi.org/10.3389/fphys.2023.1158003
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author Stoks, Job
Bear, Laura R.
Vijgen, Johan
Dendale, Paul
Peeters, Ralf
Volders, Paul G. A.
Cluitmans, Matthijs J. M.
author_facet Stoks, Job
Bear, Laura R.
Vijgen, Johan
Dendale, Paul
Peeters, Ralf
Volders, Paul G. A.
Cluitmans, Matthijs J. M.
author_sort Stoks, Job
collection PubMed
description Background: The optimal way to determine repolarization time (RT) from the intracardiac unipolar electrogram (UEG) has been a topic of debate for decades. RT is typically determined by either the Wyatt method or the “alternative method,” which both consider UEG T-wave slope, but differently. Objective: To determine the optimal method to measure RT on the UEG. Methods: Seven pig hearts surrounded by an epicardial sock with 100 electrodes were Langendorff-perfused with selective cannulation of the left anterior descending (LAD) coronary artery and submersed in a torso-shaped tank containing 256 electrodes on the torso surface. Repolarization was prolonged in the non-LAD-regions by infusing dofetilide and shortened in the LAD-region using pinacidil. RT was determined by the Wyatt (t(Wyatt)) and alternative (t(Alt)) methods, in both invasive (recorded with epicardial electrodes) and in non-invasive UEGs (reconstructed with electrocardiographic imaging). t(Wyatt) and t(Alt) were compared to local effective refractory period (ERP). Results: With contact mapping, mean absolute error (MAE) of t(Wyatt) and t(Alt) vs. ERP were 21 ms and 71 ms, respectively. Positive T-waves typically had an earlier ERP than negative T-waves, in line with theory. t(Wyatt) -but not t(Alt)-shortened by local infusion of pinacidil. Similar results were found for the non-invasive UEGs (MAE of t(Wyatt) and t(Alt) vs. ERP were 30 ms and 92 ms, respectively). Conclusion: The Wyatt method is the most accurate to determine RT from (non) invasive UEGs, based on novel and historical analyses. Using it to determine RT could unify and facilitate repolarization assessment and amplify its role in cardiac electrophysiology.
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spelling pubmed-101194092023-04-22 Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited Stoks, Job Bear, Laura R. Vijgen, Johan Dendale, Paul Peeters, Ralf Volders, Paul G. A. Cluitmans, Matthijs J. M. Front Physiol Physiology Background: The optimal way to determine repolarization time (RT) from the intracardiac unipolar electrogram (UEG) has been a topic of debate for decades. RT is typically determined by either the Wyatt method or the “alternative method,” which both consider UEG T-wave slope, but differently. Objective: To determine the optimal method to measure RT on the UEG. Methods: Seven pig hearts surrounded by an epicardial sock with 100 electrodes were Langendorff-perfused with selective cannulation of the left anterior descending (LAD) coronary artery and submersed in a torso-shaped tank containing 256 electrodes on the torso surface. Repolarization was prolonged in the non-LAD-regions by infusing dofetilide and shortened in the LAD-region using pinacidil. RT was determined by the Wyatt (t(Wyatt)) and alternative (t(Alt)) methods, in both invasive (recorded with epicardial electrodes) and in non-invasive UEGs (reconstructed with electrocardiographic imaging). t(Wyatt) and t(Alt) were compared to local effective refractory period (ERP). Results: With contact mapping, mean absolute error (MAE) of t(Wyatt) and t(Alt) vs. ERP were 21 ms and 71 ms, respectively. Positive T-waves typically had an earlier ERP than negative T-waves, in line with theory. t(Wyatt) -but not t(Alt)-shortened by local infusion of pinacidil. Similar results were found for the non-invasive UEGs (MAE of t(Wyatt) and t(Alt) vs. ERP were 30 ms and 92 ms, respectively). Conclusion: The Wyatt method is the most accurate to determine RT from (non) invasive UEGs, based on novel and historical analyses. Using it to determine RT could unify and facilitate repolarization assessment and amplify its role in cardiac electrophysiology. Frontiers Media S.A. 2023-04-07 /pmc/articles/PMC10119409/ /pubmed/37089414 http://dx.doi.org/10.3389/fphys.2023.1158003 Text en Copyright © 2023 Stoks, Bear, Vijgen, Dendale, Peeters, Volders and Cluitmans. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Stoks, Job
Bear, Laura R.
Vijgen, Johan
Dendale, Paul
Peeters, Ralf
Volders, Paul G. A.
Cluitmans, Matthijs J. M.
Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited
title Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited
title_full Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited
title_fullStr Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited
title_full_unstemmed Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited
title_short Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited
title_sort understanding repolarization in the intracardiac unipolar electrogram: a long-lasting controversy revisited
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119409/
https://www.ncbi.nlm.nih.gov/pubmed/37089414
http://dx.doi.org/10.3389/fphys.2023.1158003
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