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Techniques for Intraoperative Mapping of Tachyarrhythmias in Preexcitation Syndromes

  • H. Gareth Tobler
  • Robert W. Anderson
  • W. Steves Ring
  • David G. Benditt

Abstract

Advances in both cardiac surgery and the technology of recording and displaying electrical signals from biologic tissues have contributed to the evolution of intraoperative electrophysiologic evaluation in patients with preexcitation syndromes. As early as 1930, Barker [1] demonstrated the feasibility of epicardial electrogram recordings in the human heart and reported activation times at ventricular epicardial sites in a patient with a chronically open chest wound (Figure 25-1). In 1967, Durrer and Roos [2] obtained activation times determined from unipolar ventricular electrograms and demonstrated very early excitation at the lateral aspect of the base of the right ventricle in a patient with atrial septal defect and Wolff-Parkinson-White (WPW) syndrome. In that same year Burchell et al. [3] utilized ventricular activation times to evaluate ventricular excitation during sinus rhythm, and atrial activation times to evaluate atrial excitation during tachycardia in a patient with atrial septal defect and WPW syndrome. Even though the attempt to interrupt the accessory connection in this patient was unsuccessful, demonstration of the proximity of the site of early ventricular activation during prexcitation to the early site of atrial activation during tachycardia was important in establishing and defining the role of intraoperative electrophysiologic recordings in localizing the site of surgical exploration or accessory connetion ablation (Figure 25-2). In 1968, a report from Duke University described the successful surgical ablation of an accessory connection [4]; the localization of the accessory connection was determined from the ventricular epicardial excitation sequence (isochrone map).

Keywords

Electrode Pair Delta Wave Graphic Tablet Bipolar Electrogram Pace Electrode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Barker PS, Macleod AG, Alexander J: The excitatory process observed in the exposed human heart. Am. Heart J. 5: 720, 1930.CrossRefGoogle Scholar
  2. 2.
    Durrer D, Roos JP: Epicardial excitation of the ventricles in a patient with Wolff-ParkinsonWhite syndrome (type B). Circulation 35: 15, 1967.PubMedGoogle Scholar
  3. 3.
    Burchell HB, Frye RL, Anderson MW, McGoon DC: Atrioventricular and ventriculoatrial excitation in Wolff-Parkinson-White syndrome (type B): Transitory ablation at surgery. Circulation 36: 663, 1967.PubMedGoogle Scholar
  4. 4.
    Cobb FR, Blumenschein SD, Sealy WC, Bioneau JP, Wagner GS, Wallace AG: Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 38: 1018, 1968.PubMedGoogle Scholar
  5. 5.
    Scher AM, Young AC: The pathway of ventricular depolarization in the dog. Circ. Res. 4: 461, 1956.PubMedGoogle Scholar
  6. 6.
    Horowitz LN, Alexander JA, Edmunds LH: Postoperative right bundle branch block: Identification of three levels of block. Circulation 62: 2, 1980.Google Scholar
  7. 7.
    Wyndham MB, Smith T, Meeran MK, Mammana R, Levitsky S, Rosen KM: Epicardial activation in patients with left bundle branch block. Circulation 61: 4, 1980.Google Scholar
  8. 8.
    Wyndham CR, Meeran MK, Smith T, Engelman RM, Levitsky S, Rosen KM: Epicardial activation in human left anterior fascicular block. Am. J. Cardiol. 44: 638, 1979.PubMedCrossRefGoogle Scholar
  9. 9.
    Gallagher JJ, Kasell J, Sealy WC, Pritchett ELC, Wallace AG: Epicardial Mapping in the WolffParkinson-White Syndrome. Circulation 57: 5, 1978.Google Scholar
  10. 10.
    Waldo AL, Pacifico AD, Bargeron LM Jr, James TN, Kirklin JN: Electrophysiologic delineation of the specialized A-V conduction system in patients with corrected transposition of the great vessels and ventricular septial defect. Circulation 52: 435, 1975.PubMedGoogle Scholar
  11. 11.
    Krongrad E, Malm JR, Bowman FO, Jr, Hoffman BF, Kaiser GA, Waldo AL: Electrophysiologic delineation of the specialized atrioventricular conduction system in patients with congenital heart disease. J. Thorac Cardiovasc. Surg. 67: 875, 1974.PubMedGoogle Scholar
  12. 12.
    Gallagher JJ, Pritchett ELC, Sealy WC, Kasell J, Wallace AG: The Preexcitation Syndromes. Prog. Cardiovasc. Dis. 20: 285, 1978.PubMedCrossRefGoogle Scholar
  13. 13.
    Gallagher JJ, Pritchett ELC, Benditt DG, Tonkin AM, Campbell RWF, Dugan FA, Bashore TM, Wallace AG: New catheter techniques for analysis of the sequence of antegrade atrial activation in man. Eur. J. Cardiol. 6: 1, 1977.PubMedGoogle Scholar
  14. 14.
    Kupersmith J: Electrophysiologic mapping during open heart surgery.Prog. Cardiovasc. Dis. 23: 167, 1976.CrossRefGoogle Scholar
  15. 15.
    Gallagher JJ, Sealy WC, Kasell J, Millar R, Campbell RWF, Harrison L, Pritchett ELC, Wallace AG: Cryosurgical ablation of accessory atrioventricular connections: a new technique for correction of the preexcitation syndrome. Circulation 44: 471, 1977.Google Scholar
  16. 16.
    Jackman W, Beck B, Aliot E, Friday K, Lazzara R: Basis for concealed accessory AV pathways. (Abstract.) Circulation 70: I1–337, 1984.CrossRefGoogle Scholar
  17. 17.
    Harrison L, Ideker RE, Smith WM, Klein GJ, Kasell J, Gallagher JJ: The sock electrode array. A tool for determining global epicardial activation during unstable arrhythmias. PACE 3: 531, 1980.PubMedCrossRefGoogle Scholar
  18. 18.
    Witowski FX, Corr PB: An automated, simultaneous transmural cardiac mapping system. Am. J. Physical. 247 (Heart Circ Physical): H661, 1984.Google Scholar
  19. 19.
    Meijne NG, Mellink HM, van Dam RT, Durrer D: Surgical treatment of ventricular preexcitation. J. Thor. Cardiovasc. Surg. 14: 232, 1973.Google Scholar
  20. 20.
    Barr RC, Spach MS: Sampling rates required for digital recording of intracellular and extracellular cardiac potentials. Circulation 55: 40, 1977.PubMedGoogle Scholar
  21. 21.
    Kasell J, Gallagher JJ: A digital timer for on-line interval measurement. PACE 4: 497, 1981.PubMedCrossRefGoogle Scholar
  22. 22.
    Fontaine G, Guiraudon G, Frank R, Coutte R, Dragodanne C: Epicardial mapping and surgical treatment in six cases of resistant ventricular tachycardia not related to coronary artery disease. In The Conduction System of the Heart, Wellens HJJ, Lie KI, Janse MJ (eds.). The Netherlands, Martinus Nijhoff, 1976, pp. 543563.Google Scholar
  23. 23.
    Smith WM, Ideker RE: Computer techniques for epicardial and endocardial mapping. Prog. Cardiovasc. Dis. 26: 15, 1983.PubMedCrossRefGoogle Scholar
  24. 24.
    Gallagher JJ, Kasell JH, Cox JL, Smith WM, Ideker RE, Smith WM: Techniques of intra-operative electrophysiologic mapping.Am. J. Cardiol. 49: 221, 1982.PubMedCrossRefGoogle Scholar
  25. 25.
    Parson I, Downar E: Clinical Instrumentation for the Intra-operative mapping of ventricular arrhythmias. PACE 7: 683, 1984.PubMedCrossRefGoogle Scholar
  26. 26.
    Janse MJ, van Capelle FJL, Marsink H, Kleber AG, Wilms-Schapman F, Cardinal R, D’Alnoncourt CN, Durrer D: Flow of “injury” current and patterns of excitation during early ventricular arrhythmias in acute regional myocardial ischemia in isolated porcine and canine hearts: Evidence for two different arrhythmogenic mechanisms. Circ. Res. 47: 151, 1980.PubMedGoogle Scholar
  27. 27.
    Wyatt RF, Lux RL: Application of multiplexing techniques in the collection of body surface maps from single complexes. Adv. Cardiol. 10: 26, 1974.Google Scholar
  28. 28.
    Mendier P, Parson I, Downar E: Multichannel recording of cardiac potentials. Med. Biol. Eng. Comput. 18: 617, 1980.CrossRefGoogle Scholar
  29. 29.
    Sadowski AR, Moyers JR: Anesthetic Management of the Wolff-Parkinson-White Syndrome. Anesthesiology 51: 553, 1979.PubMedCrossRefGoogle Scholar
  30. 30.
    van der Starre PJA: Wolff-Parkinson-White syndrome during anesthesia. Anesthesiology 48: 369, 1978.PubMedCrossRefGoogle Scholar
  31. 31.
    Katz J Kadis L: Anesthesia and Uncommon Diseases. Philadephia, WB Saunders, 1973.Google Scholar
  32. 32.
    Hammill SC, Pritchett ELC Klein GJ, Smith WM, Gallagher JJ: Accessory atrioventricular pathways that conduct only in the antegrade direction. Circulation 62: 1335, 1980.PubMedGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing 1986

Authors and Affiliations

  • H. Gareth Tobler
  • Robert W. Anderson
  • W. Steves Ring
  • David G. Benditt

There are no affiliations available

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