Epicardial excitation during ventricular pacing: Relative independence of breakthrough sites from excitation sequence in canine right ventricle

Abstract

In a previous investigation, epicardial recordings with 1,124 closely spaced electrodes revealed 20-35 breakthrough (BKT) sites and an equal number of separate wave fronts on the ventricular surface of exposed dog hearts during normal sinus rhythm. In the present study we tried 1) to determine whether ventricular pacing also produced multiple BKTs and wave fronts and 2) to determine whether the number and location of BKTs were, to some degree, independent of pacing site. The study mainly focused on right ventricular BKTs observed during right ventricular pacing. To test hypotheses 1 and 2 we identified many breakthrough sites during sinus rhythm in seven exposed dog hearts and then paced the heart from several BKT and non-BKT sites on the right ventricle. Epicardial potential maps and excitation time maps were obtained by using 1,124 epicardial electrodes covering the anterior right ventricle and part of the anterior left ventricle. A primary wave front spread radially for several centimeters from the pacing site, and no BKTs appeared in the areas covered by the primary wave front. In the remaining areas (secondary areas), multiple BKTs appeared; their number was close to that observed during sinus rhythm in the same areas (113 versus 115, respectively, in 12 paced beats). The majority of paced BKTs (83 out of 115, or 72%) occurred exactly at the same locations where they appeared during sinus rhythm. However, 30 right ventricular BKTs observed during sinus rhythm disappeared in the secondary areas and were replaced by approximately the same number of new BKTs. Many areas without BKTs in normal beats remained so in paced beats. We conclude that during right ventricular pacing, epicardial excitation on the right ventricle exhibits multiple BKTs whose location is partially independent of pacing site and probably reflects structural properties of the ventricular wall.