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Author Notes:

Correspondence to: Antonis A. Armoundas, PhD, Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129. E-mail: aarmoundas@partners.org

The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.

Disclosures: none.

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Research Funding:

This work was supported by a Scientist Development Grant (0635127N), a Founders Affiliate Postdoctoral Fellowship (12POST9310001) from the American Heart Association, the Kenneth M. Rosen Fellowship in Cardiac Pacing and Electrophysiology (13‐FA‐32‐HRS) from the Heart Rhythm Society, and by NIH grant 1R21AG035128.

This work was also supported by a Fellowship and a Science Award from the Center for Integration of Medicine and Innovative Technology (CIMIT), by the Spanish government (MINECO) and European Union (FEDER) under projects TEC2010‐21703‐C03‐02 and TEC2013‐42140‐R and by the European Social Fund and the Aragon government under Grupo Consolidado BSICoS.

This work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170‐05 and financial contributions from Harvard University and its affiliated academic health care centers).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • ECG delineation
  • intracardiac signals
  • ischemic index
  • myocardial infarction
  • wavelet transform
  • ACUTE MYOCARDIAL-ISCHEMIA
  • CORONARY-ARTERY OCCLUSION
  • FREQUENCY QRS COMPONENTS
  • SUB-ENDOCARDIAL ISCHEMIA
  • ST-SEGMENT DEVIATION
  • QT INTERVAL
  • INFARCTION
  • STANDARD
  • ECG
  • LEAD

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

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Journal Title:

Journal of the American Heart Association

Volume:

Volume 3, Number 5

Publisher:

, Pages e001055-e001055

Type of Work:

Article | Final Publisher PDF

Abstract:

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. 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<0.0016) and right ventricle-coronary sinus (P<0.0011) leads, 60 seconds in coronary sinus leads (P<0.0002), 90 seconds in right ventricle leads (P<0.0020), and 360 seconds in body-surface electrocardiographic signals (P<0.0022). Intracardiac leads exhibited a higher probability of detecting ischemia-induced changes than body-surface leads (P<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<0.0388). Finally, we showed that the ischemic index in intracardiac electrograms is significantly increased preceding ventricular tachyarrhythmic events (P<0.0360). 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.

Copyright information:

© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/).

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