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European Heart Journal 1992 13(3):310-315;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

The interrelation between the monophasic action potential duration, cycle length and ischaemia in the human left ventricle

R. M. JOHN, P. I. TAGGART, P. M. SUTTON*, P. J. ELL{dagger} and H. SWANTON

Department of Cardiology, The Middlesex Hospital London
*Department of Physiology University College and Middlesex School of Medicine London, U.K.
{dagger}Institute of Nuclear Medicine, University College and Middlesex School of Medicine London, U.K.

Received 30 October 1990; revised 13 March 1991; .

Correspondence: Dr Roy M John, MRCP. Department of Medicine- Division of Cardiology. The V.A Medical Centre. 1400 VFW Parkway. West Roxbury, MA 02132, U.S.A.

Abstract

Steady state monophasic action potentials were recorded from a single site in the left ventricular endocardium during incremental atrial pacing to the point of angina in 25 patients. Ischaemic areas of the left ventricle were documented using a perfusion marker (99m Tc-MIBI) simultaneously with the action potential recording procedure. Recordings were obtained from an ischaemic area in 13 patients and from a non-ischaemic area in 12. A linear correlation between action potential duration and cycle length changes was demonstrated for both ischaemic and non-ischaemic zone recordings between cycle length changes of 750 and 428 ms. Ischaemia induced a shortening of the action potential duration significantly greater than that produced by cycle length changes (P<0.0001). Mean action potential duration shortening corrected for l00ms change in cycle length for ischaemic zone recordings was 31.4±4.2 (SD) compared to 23.3±3.1 ms for non-ischaemic zone recordings. A range of values of action potential duration shortening in unit time was analysed for sensitivity and specificity for the detection of ischaemia. A value of 26.5 ms per 100 ms change in cycle length provided the optimum compromise with 88% sensitivity and specificity. Our data provide a means of employing the monophasic action potential duration to quantify early localized ischaemia in the presence of an alteration in cycle length.

Key Words: Monophasic action potential duration • ischaemia • cycle length • let ventricular endocardium • atrial pacing


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