Interpretation of Isopotential Surface Maps in Patients with Ostium Primum and Secundum Atrial Defects

Author:

KARSH RICHARD B.1,SPACH MADISON S.1,BARR ROGER C.1

Affiliation:

1. From the Department of Pediatrics and Division of Biomedical Engineering, Duke University, Durham, North Carolina.

Abstract

The purpose of this study was to determine if there were consistent differentiating patterns in body surface potential maps in children with normal hearts and in those with ostium primum versus ostium secundum atrial septal defects. A second purpose was to interpret the isopotential surface maps in terms of the position of intracardiac electrical wave fronts. Body surface activity throughout QRS demonstrated three major intervals: developing, transitional, and declining potentials. Patients with both types of atrial septal defects demonstrated complex distributions (multiple maxima) during the transitional interval which were not encountered in normal subjects. In the primum group, the distribution of positive and negative potentials sequentially changed in an inverted pattern as compared to the pattern in those patients with secundum defects. Furthermore, during the transitional interval the potential distribution was considerably more complex in the primum group. In two additional patients, body surface maps were helpful in clarifying misleading and atypical conventional electrocardiograms. The presence of simultaneous multiple maxima could only be accounted for by the existence of multiple wave fronts simultaneously present within the heart. In particular the emergence of two widely separated anterior chest maxima in patients with secundum atrial defect indicated the simultaneous presence of prominent left and right ventricular wave fronts. Also, the marked differences in the relative positions of the major body surface maximum and minimum could be accounted for only by considerable differences in the position and extent of intracardiac wave fronts. For example, the target distribution, consisting of an isolated minimum surrounded by multiple maxima and positive potentials over the upper body, in the ostium primum patients, indicated epicardial breakthrough in a wave front positioned in the anterosuperior portion of the heart. In contrast, normal subjects and patients with secundum defect had distributions indicating antero-inferior wave front position at the time of right ventricular epicardial breakthrough.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference5 articles.

1. The genesis of the electrocardiogram of patients with ostium primum defects (ventral atrial septal defects)

2. Epicardial and intramural excitation of normal heart in six patients 50 years of age and older.

3. Electrical Aspects of Human Cardiac Activity: A Clinical-Physiological Approach to Excitation and Stimulation

4. com.atypon.pdfplus.internal.model.plusxml.impl.AuthorGroup@523d9a6b : Genesis of the vectorcardiogram (electrocardiogram) in endocardial cushion defects. Proc Long Island Jewish Hosp Sympos um on Vectorcardiography. Amsterdam North-Holland Publishing Co 1966 p 307

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