A Novel Method to Capture the Onset of Dynamic Electrocardiographic Ischemic Changes and its Implications to Arrhythmia Susceptibility

作者：Sayadi Omid; Puppala Dheeraj; Ishaque Nosheen; Doddamani Rajiv; Merchant Faisal M; Barrett Conor; Singh Jagmeet P; Heist E Kevin; Mela Theofanie; Pablo Martinez Juan; Laguna Pablo; Armoundas Antonis A^*

来源：Journal of the American Heart Association, 2014, 3(5): e001055.

DOI：10.1161/JAHA.114.001055

• ECG delineation
• intracardiac signals
• ischemic index
• myocardial infarction
• wavelet transform

Background-This study investigates the hypothesis that morphologic analysis of intracardiac electrograms provides a sensitive approach to detect acute myocardial infarction or myocardial infarction-induced arrhythmia susceptibility. Large proportions of irreversible myocardial injury and fatal ventricular tachyarrhythmias occur in the first hour after coronary occlusion; therefore, early detection of acute myocardial infarction may improve clinical outcomes. %26lt;br%26gt;Methods and Results-We developed a method that uses the wavelet transform to delineate electrocardiographic signals, and we have devised an index to quantify the ischemia-induced changes in these signals. We recorded body-surface and intracardiac electrograms at baseline and following myocardial infarction in 24 swine. Statistically significant ischemia-induced changes after the initiation of occlusion compared with baseline were detectable within 30 seconds in intracardiac left ventricle (P%26lt;0.0016) and right ventricle-coronary sinus (P%26lt;0.0011) leads, 60 seconds in coronary sinus leads (P%26lt;0.0002), 90 seconds in right ventricle leads (P%26lt;0.0020), and 360 seconds in body-surface electrocardiographic signals (P%26lt;0.0022). Intracardiac leads exhibited a higher probability of detecting ischemia-induced changes than body-surface leads (P%26lt;0.0381), and the right ventricle-coronary sinus configuration provided the highest sensitivity (96%). The 24-hour ECG recordings showed that the ischemic index is statistically significantly increased compared with baseline in lead I, aVR, and all precordial leads (P%26lt;0.0388). Finally, we showed that the ischemic index in intracardiac electrograms is significantly increased preceding ventricular tachyarrhythmic events (P%26lt;0.0360). %26lt;br%26gt;Conclusions-We present a novel method that is capable of detecting ischemia-induced changes in intracardiac electrograms as early as 30 seconds following myocardial infarction or as early as 12 minutes preceding tachyarrhythmic events.

• 出版日期2014-10