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European Heart Journal 2004 25(2):151-157; doi:10.1016/j.ehj.2003.10.019
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Direct epicardial mapping predicts the recovery of left ventricular dysfunction in chronic ischaemic myocardium

Christian Vahlhausa,*, Hans-Jürgen Brunsa, Jörg Stypmanna, Tonny D.T Tjanb, Frauke Janssenb, Michael Schäfersc, Hans H Scheldb, Otmar Schoberc, Günter Breithardta and Thomas Wichtera

a Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany
b Department of Thoracic and Cardiovascular Surgery, Hospital of the University of Münster, Münster, Germany
c Department of Nuclear Medicine, Hospital of the University of Münster, Münster, Germany

* Correspondence to: Dr Christian Vahlhaus, Universitätsklinikum Münster, Medizinische Klinik und Poliklinik C-, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany. Tel: +49-251-83-48370; Fax: +49-251-83-47864
E-mail address: Vahlhaus{at}uni-muenster.de

Received 5 June 2003; revised 30 September 2003; accepted 16 October 2003

Abstract

Aims This study investigated the hypothesis that direct epicardial bipolar mapping is able to predict the recovery of left ventricular (LV) dysfunction in ischaemic myocardium.

Methods and results In 34 patients with CAD, a maximum of 102 bipolar epicardial electrograms per patient (n=3468 electrograms) were simultaneously recorded with a ventricular jacket array intraoperatively immediately prior to revascularization. Only LV electrograms with good myocardial contact (n=1813, 52±14 per patient, mean±SD) were analyzed. In accordance to the position of each electrode, segmental myocardial function was assessed by transthoracic echocardiography before and 7±2 months (mean±SD; range 3–10 months) after CABG using a wall motion score. Preoperatively dysfunctional segments (n=700) were classified as viable (improvement in wall motion score of at least 20% following CABG, n=424) or non-viable (no improvement, n=276). Bipolar voltage was significantly lower in non-viable when compared to viable myocardium (P<0.001, ANOVA) At a cut-off value of 5.9mV, ROC-curve analysis for bipolar voltage (to discriminate between viable and non-viable myocardium) revealed a sensitivity of 83% at a specificity of 83% (area under the ROC-curve of 0.92±0.01, mean±SE).

Conclusion Direct epicardial mapping is able to predict the recovery of chronically ischaemic dysfunctional myocardium and thereby proves the presence of myocardial viability.

Key Words: ECG • Myocardial viability • Mapping


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C. Vahlhaus, H. J. Bruns, G. Breithardt, and T. Wichter
Direct epicardial mapping predicts the recovery of left ventricular dysfunction in chronic ischaemic myocardium: Reply
Eur. Heart J., August 1, 2004; 25(15): 1367 - 1368.
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