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La activación epicárdica y endocárdica durante la taquicardia ventricular sostenida en el hombre
Circulation
|June 1, 1980
Resumen
Este estudio muestra que la taquicardia ventricular en la enfermedad cardíaca isquémica se origina cerca de la superficie endocárdica del infarto de miocardio. El mapeo epicárdico por sí solo es insuficiente para identificar el origen de estas taquicardias ventriculares.
Área de la Ciencia:
- Cardiología Cardiología.
- Electrofisiología y electrofisiología.
- Cirugía cardíaca Cirugía cardíaca.
Sus antecedentes:
- La taquicardia ventricular recurrente (VT) es una complicación significativa en pacientes con enfermedad arterial coronaria (CAD) y infarto de miocardio (IM).
- La identificación precisa del origen de la VT es crucial para un tratamiento eficaz, que a menudo implica una intervención quirúrgica.
Objetivo del estudio:
- Para investigar el origen preciso de la activación ventricular durante la terapia ventricular en pacientes con enfermedad isquémica del corazón.
- Evaluar la suficiencia del mapeo epicárdico frente al mapeo combinado epicárdico y endocárdico para identificar el sustrato de VT.
Principales métodos:
- Se realizó un mapeo epicárdico y endocardiano intraoperatorio en 21 pacientes con EAC y MI previo sometidos a cirugía por VT recurrente.
- Las taquicardias ventriculares (29 morfologías distintas) fueron inducidas y mapeadas utilizando extensas grabaciones de electrogramas (55-75 epicárdicas, 28-55 endocárdicas).
- Los datos de mapeo se analizaron junto con ECG y electrogramas de referencia para determinar los sitios de activación más tempranos.
Principales resultados:
- La activación ventricular más temprana se produjo consistentemente en la superficie endocardiana del área de infarto en todas las taquicardias mapeadas.
- La actividad eléctrica endocardiana precedió a la aparición del complejo QRS, lo que indica el origen.
- La activación epicárdica más temprana se retrasó (10 ms después del QRS), con un avance epicárdico en ambos ventrículos.
Conclusiones:
- La taquicardia ventricular en la enfermedad isquémica del corazón se origina en la superficie endocárdica del ventrículo izquierdo, adyacente al límite del infarto.
- El mapeo epicárdico por sí solo es inadecuado para localizar con precisión el origen de estos sustratos VT.
- El mapeo combinado endocárdico y epicárdico es esencial para la identificación precisa del origen de VT en esta población de pacientes.
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