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@article{Shun-Shin:2019:europace/euz015,
author = {Shun-Shin, MJ and Leong, KMW and Ng, FS and Linton, NWF and Whinnett, ZI and Koa-Wing, M and Qureshi, N and Lefroy, DC and Harding, SE and Lim, PB and Peters, NS and Francis, DP and Varnava, AM and Kanagaratnam, P},
doi = {europace/euz015},
journal = {EP-Europace},
pages = {1422--1431},
title = {Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress},
url = {http://dx.doi.org/10.1093/europace/euz015},
volume = {21},
year = {2019}
}

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TY  - JOUR
AB  - AIMS: Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise. METHODS AND RESULTS: Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50). CONCLUSION: We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.
AU  - Shun-Shin,MJ
AU  - Leong,KMW
AU  - Ng,FS
AU  - Linton,NWF
AU  - Whinnett,ZI
AU  - Koa-Wing,M
AU  - Qureshi,N
AU  - Lefroy,DC
AU  - Harding,SE
AU  - Lim,PB
AU  - Peters,NS
AU  - Francis,DP
AU  - Varnava,AM
AU  - Kanagaratnam,P
DO  - europace/euz015
EP  - 1431
PY  - 2019///
SN  - 1099-5129
SP  - 1422
TI  - Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress
T2  - EP-Europace
UR  - http://dx.doi.org/10.1093/europace/euz015
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30820561
UR  - https://academic.oup.com/europace/article/21/9/1422/5366944
UR  - http://hdl.handle.net/10044/1/68694
VL  - 21
ER  -

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