Background: Mapping techniques to identify diseased myocardial substrate during ventricular tachycardia ablation procedures remain limited.
Objective: We hypothesized that tissue derivative of the voltage with respect to time (dV/dt), the slope of the unipolar ventricular electrogram registered by local ventricular activation, represents a unique parameter for identifying potential arrhythmogenic tissue in the ischemic scar border zone.
Methods: Using high-resolution electrical mapping, we examined dV/dt characteristics in the border zone of animals after chronic myocardial infarction (MI).
Results: Minimum dV/dt (dV/dt) in MI animals was less than that in control animals (-344.7 ± 68.7 in controls vs -174.2 ± 104.5 in MI; P < .001) and related to ventricular fibrosis. In MI animals, dV/dt values were divided into high (≤-200 μV/ms) and low (>-200 μV/ms) dV/dt. Low dV/dt regions harbored arrhythmogenic substrates that were characterized by (1) high responsiveness to sympathetic stimulation, (2) presence of late potentials, and (3) lower unipolar and bipolar voltage amplitudes.
Conclusion: Our data indicate that dV/dt is a unique parameter for identifying arrhythmogenic myocardium and may add a useful metric to conventional mapping strategies.
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