ArticleHeart rhythm O22026
Spatiotemporal heterogeneity of activation alternans in cardiomyopathy: Implications for risk stratification with microvolt QRS alternans.
Article in Heart rhythm O2, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Microvolt QRS alternans (QRSA) on the surface electrocardiogram is a strong predictor of ventricular arrhythmia (VA) in patients with cardiomyopathy (CM); however, its intracardiac origin has not been defined. Objective: This study aimed to assess the spatiotemporal features of intracardiac activation alternans (AA) in relation to body surface QRSA and VA. Methods: Unipolar electrograms were recorded from the great cardiac vein (left ventricular epicardium) and the right ventricular endocardium in 10 patients with CM (age 59 ± 16 years; left ventricular ejection fraction 32% ± 9%). Unipolar AA and surface QRSA were quantified using the spectral method during consecutive atrial pacing at 75, 100, and 120 beats per minute. AA was simulated with a 1500-node heart model to assess the relationship with surface QRSA. Patients were followed for VA over 5 years. Results: AA was more prevalent in the left ventricular epicardium than the right ventricular endocardium (25% vs 5% of recording electrodes; Conclusion: AA exhibits substantial spatiotemporal heterogeneity in patients with CM and is dependent on heart rate. Surface microvolt QRSA is the noninvasive manifestation of intracardiac AA, which may explain its prognostic utility.
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