An analysis of transfer coefficients calculated directly from epicardial and body surface potential measurements in the intact dog.
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Biomedical subjects
Publications and source records attributed to M S Spach.
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Electrocardiograms and cardiac electrograms now frequently are measured for both clinical and experimental purposes by direct digital sampling, with no recording of the signal in analog form. This study examined the question of what sampling rates were required to measure accurately the continuous waveforms from the digital samples. Body surface waveforms and intracellular and extracellular waveforms measured directly from cardiac tissues were evaluated. Cardiac measurements included waveforms from the atrium, ventricle, atrioventricular transmission system and individual Purkinje strands. Sampling rates as high as 15,000 samples/sec were required to record accurately extracellular waveforms of the ventricular conduction system. Decreasing sampling rates were required as the recording site shifted through the ventricle to the body surface, where sampling rates as high as 1500 samples/sec were necessary.
Epicardial and body surface QRS-T wave potential distributions were measured during normal and ectopic sequences in intact chimpanzees. Epicardial potential distributions were used because they provide a comprehensive picture of total cardiac electrical activity for relating heart and body surface events during both ventricular activation and repolarization. When the epicardial potential gradients existed over a distance greater than that to the recording points on the body surface, e.g., as occurred during the overlap of terminal ventricular activation and early repolarization, the epicardial events were mirrored well on the anterior chest surface. However, when the recording points were at a distance greater than that over which the epicardial potential gradients existed, the details of the epicardial events disappeared and their effect was to produce distinct changes in the low-level potentials over broad distant areas. The major manifestations on the body surface of selective epicardial events frequently were changes in the distant low-level potential areas while there was no change in the pattern near the maximum or minimum. The ST-T wave body surface distributions were as useful as the QRS patterns for localizing the ventricular ectopic foci presented. A direct experimental basis is provided for explaining T wave notches which occurred during normal and ectopic beats and resembled U waves. It should be possible to achieve as precise an understanding of ST-T waves on the basis of epicardial potential distributions as has thus far been achieved for QRS on the basis of isochrones.
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Ventricular repolarization was analyzed by measuring epicardial potential distributions in intact dogs with single or multiple ectopic foci and a minimum at the terminal site(s) of excitation. During the latter half of the T wave the distributions became more complex, and two maxima evolved from the initial one at each ectopic site. The measured epicardial potentials were simulated by means of a model of ST-T wave events that is suitable for study of single and multiple ectopic beats with fusion, a a model we call 'SI model.' Intracellular potentials around the ventricles during repolarization were calculated from measured excitation sequences and known action potential shapes. The extracellular potentials around the ventricles were computed from the intracellular ones by a simplified ventricular geometry. The satisfactory agreement between the theoretical and measured extracellular potential distribution shows that the complex changes which occur throughout the ST-T wave are predicted well on the basis of changes in the intracellular potential distributions. In contrast to the well known lability of the T wave from beat, the results show that for any single beat the events of repolarization proceed in an entirely repeatable and deterministic fashion. The results present a way to directly represent cardiac extracellular events during the ST-T wave, a method analogous to the use of isochromes during QRS, and they imply that in the future it will by possible to achieve a more precise quantitative understanding of the events of the ST-T wave than thus far has been possible for QRS.
A 5-year-old boy had clinical, cardiac catheterization, and operative findings of a thoracic arteriovenous fistula arising from the right subclavian artery. The venous connection was to the paravertebral plexus with eventual drainage into the inferior vena cava through the right common iliac vein. To our knowledge, this type of fistula has not been reported previously and is believed to represent embryological defects of the first or second posterior intercostal arteries as well as maldevelopment of the venous connections of azygos vein to the superior vena cava, which resulted in the observed caudal venous pathways becoming operative.
Ventricular intramural and epicardial potential distributions were measured during normal excitation and repolarization in intact dogs. Potential distributions were chosen because they can be unambiguously measured, are useful in understanding the shapes of wave forms at many specific sites, and provide a direct measure of repolarization. Unipolar wave forms were recorded from intramural and epicardial electrodes and converted into potential distributions. Well-known shapes of wave forms recorded at the inner and outer layers of the ventricles as well as peak-to-peak voltages were shown by the potential distributions to be determined primarily by superposition effects of distant excitation waves. These effects were most prominent before epicardial breakthrough and then receded during the last half of the QRS complex. However, the potential distributions became more complex as excitation waves merged, collided, and terminated. During terminal depolarization, there were scattered positive repolarization potentials intramurally. Normal repolarization was characterized by positive potentials over the ventricular epicardium while there were changes intramurally and on the atrium. Throughout the T wave, there was a predominant transmural unidirectional gradient with the inner wall being more negative than the outer wall. This finding confirms that the sequence of repolarization is from the epicardium to the endocardium with the middle layers having an intermediate time.
Ventricular activation and repolarization were examined by measuring intramural and epicardial potential distributions during ectopic sequences in intact dogs. Potential distributions were used because they provided a direct measure of all of repolarization. Ectopic sequences produced almost unidirectional excitation across the heart along with repolarization events that were different from normal. During ectopic repolarization, positive potentials occurred over a broad area surrounding the ectopic focus, and negative potentials occurred over a large area on the opposite side of the heart where excitation terminated. The potentials in the walls of both ventricles were more positive in the outer layers and more negative in the inner layers, a gradient similar to normal. A maximum initially was at the ectopic site with a magnitude greater than that of the minimum, but the maximum subsequently decreased in magnitude and shifted toward the minimum while the minimum increased in magnitude. The steepest gradients were initially around the maximum, and they then shifted toward the minimum. The results show that ventricular repolatization potential distributions during ectopic beats are predominantly influenced by gradients from one side of the heart to the other (transventricular gradients) in contrast to normal repolatization distributions which are predominantly influenced by gradients across the wall (transmural gradients).
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