The spatial variation in restitution properties in relation to varying stimulus site is poorly defined. This study aimed to investigate the effect of varying stimulus site on apico-basal and transmural activation time (AT), action potential duration (APD) and repolarization time (RT) during restitution studies in the intact human heart. Ten patients with structurally normal hearts, undergoing clinical electrophysiology studies were enrolled. Decapolar catheters were placed apex to base in the endocardial right ventricle (RVendo) and left ventricle (LVendo), and an LV branch of the coronary sinus (LVepi) for transmural recording. S1-S2 restitution protocols were performed pacing RVendo apex, LVendo base and LVepi base. Overall 725 restitution curves were analyzed, 74% of slopes had an Smax>1 (p < 0.001), mean Smax=1.76. APD was shorter in the LVepi compared to LVendo regardless of pacing site (30ms difference during RVendo pacing, 25ms during LVendo and 48ms during LVepi; 50th quantile, p<0.01). Basal LVepi pacing resulted in a significant transmural gradient of RT (77ms, 50th quantile: p<0.01), due to loss of negative transmural AT-APD coupling (mean slope 0.63±0.3). No significant transmural gradient in RT was demonstrated during endocardial RV or LV pacing, with preserved negative transmural AT-APD coupling (mean slope −1.36 ±1.9 and −0.71 ±0.4, respectively). Steep ARI restitution slopes predominate in the normal ventricle and dynamic ARI, RT gradients exist which are modulated by the site of activation. Epicardial stimulation to initiate ventricular activation promotes significant transmural gradients of repolarization that could be pro-arrhythmic.
- Whole Heart
- APD Heterogeneity
- Dispersion of Repolarization
- Copyright © 2016, American Journal of Physiology - Heart and Circulatory Physiology