Author + information
- Received May 4, 1987
- Revision received October 16, 1987
- Accepted December 9, 1987
- Published online May 1, 1988.
- Ralph J Damiano Jr., MD∗∗,
- Susan M Blanchard, PhD∗,
- Tetsuo Asano, MD∗,
- James L Cox, MD, FACC† and
- James E Lowe, MD, FACC∗
- ↵∗Address for reprints: Ralph J. Damiano, Jr., MD. Department of Surgery, Box 31059, Duke University Medical Center, Durham, North Carolina 27710.
The effects of distant potentials on local epicardial unipolar electrograms were examined utilizing a model that enabled both ventricles to be paced independently in five dogs. The right ventricular isolation procedure electrically isolates the right from the left ventricle. Right ventricular electrograms were separated into their local (right ventricular) and distant (left ventricular) components by altering the left-right ventricular pacing interval. Waveform configuration, peak to peak amplitude, magnitude of the slope and timing of the fastest downstroke were carefully evaluated at each electrode site, both with and without the presence of distant left ventricular potentials.
Except for the timing of the fastest downstroke, all of these variables were significantly altered by distant potentials. Although the slope of the fastest downstroke was significantly affected by distant potentials, it remained a sensitive indicator of local versus distant activation. All electrograms of local right ventricular activation had a slope magnitude >2.5 mV/2 ms whereas none of the right ventricular electrograms containing only distant left ventricular activity had a magnitude >2.5 mV/2 ms. Computergenerated electrograms were calculated by digitally summing the recorded local right and distant left ventricular components. The simulated electrograms correlated well with the recorded electrograms during synchronous ventricular pacing.
Thus, the configuration, amplitude and slope of unipolar electrodes were profoundly influenced by distant potentials. The timing of the fastest downstroke is largely independent of the effect of distant potentials and most closely represents local activation. The magnitude of the slope of the recorded electrogram accurately distinguishes local from distant activation.
☆ This study was supported in part by Grants HL 32086, HL 25983 HL07063, HL 06568 and HL 32257 from the National Instilutes of Health, Bethesda, Maryland and by a grant from The Whitaker Foundation, Camp Hill, Pennsylvania.
- Received May 4, 1987.
- Revision received October 16, 1987.
- Accepted December 9, 1987.