Patterns of body surface potential and ventriculograms specific to occlusion of subdivisions of the coronary arteries

Abstract

The thoracic activation map patterns, the distribution of occlusions, and the ventriculograms obtained at cardiac catheterization were examined in 166 patients with multivessel coronary disease without conduction defects or prior coronary intervention. The mean potential and ventriculographic configurations were determined for 15 groups, each formed on the basis of significant luminal occlusion (≥90%) of an individual coronary arterial subdivision. We mathematically extracted distinctive map and wall motion patterns specific for isolated occlusion of each of the 15 major subdivisions. For these prototypes we found the following: 1) Definitive change in electrical pattern (> 2 SD from the normal mean) occurred frequently outside the electrode sites of the standard electrocardiogram. 2) Focal akinesis systematically followed lesion site down the arterial courses; early electrical activation patterns corresponded to identifiable anatomic loss. 3) Certain paradoxes arose, for example, similar wall motion change but quite dissimilar electrical patterns from posterior descending artery occlusion of right coronary versus left circumflex origin. This technique unmasks component surface electrical patterns and ventriculographic deformities otherwise unrecognized in multisite, multivessel disease.