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Master Thesis

Fibrillation Ventriculaire : caractéristiques invasives et non-invasives chez l'Homme

Abstract : Ventricular fibrillation (VF) is a heterogeneous arrhythmia. Due to its lethal nature, descriptive human data is scarce. Our main goal was to study the relationships between the electrical characteristics of VF episodes and the clinical characteristics of the corresponding patients. We also sought to establish links between endocardial activity and ECG recordings during VF. We performed an electrophysiological study in patients with a history of VF. Left and right ventricular (LV/RV) endocardial electrograms (EGMs) were recorded with simultaneous 12-lead ECG. VF episodes were spontaneous or triggered using a stepwise induction protocol. Dominant frequencies (DF), regularity indexes (RI), Shannon entropy (ShEn) and percentage of continuous electrical activity (CEA) markers were computed. These markers were compared to ECG markers of DF, phase and waveform amplitude. 63 VF episodes from 36 patients were analyzed. Electrical characteristics depended on VF induction mode, site and underlying substrate. Burst pacing induction produced faster and more disorganized arrhythmias, identified by higher DFs, ShEn and CEA markers. The different electrical diseases studied exhibited distinct electrical phenotypes during VF. Overall, they produced faster and more disorganized arrhythmias than observed in structurally damaged hearts. Patients induced from the RV displayed a right to left phase gradient on ECG recordings that was absent in patients induced from the LV. Endocardial DF correlated strongly with surface DF and low surface ECG waveform amplitudes correlated with high values of CEA and ShEn, indicating disorganized underlying electrical activity. VF phenotype is dependent on the underlying substrate and mode and site of induction. Surface ECG recordings provide information about the underlying electrical activity and may give an idea of arrhythmia organization. These findings must be taken into consideration for further mechanistic studies of VF.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01592015
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Submitted on : Friday, September 22, 2017 - 2:25:23 PM
Last modification on : Friday, October 27, 2017 - 1:15:46 AM
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Josselin Duchateau. Fibrillation Ventriculaire : caractéristiques invasives et non-invasives chez l'Homme. Médecine humaine et pathologie. 2016. ⟨dumas-01592015⟩

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