Recognition of the epicardial breakthrough on body surface isopotential maps: influence of the inter-electrode distance on the patterns reflecting the epicardial breakthrough.

The epicardial breakthrough can be recognized from the localized depression of the body surface potential, which is characterized by a localized bend of the equipotential lines or a send-minimum on isopotential maps. Recognition of epicardial breakthrough with isopotential maps enables us to diagnose location of the block site of the bundle branch blocks more precisely than by ECG or VCG. However, the optimum inter-electrode distance for detection of such a localized potential has not been determined. In the present study, influence of the inter-electrode distance on the characteristic patterns reflecting the epicardial breakthrough was studied on 16 healthy persons using 9 x 9 electrode arrays with inter-electrode distance of 1.25 cm, 5 x 5 with 2.5 cm, and 3 x 3 with 5 cm. Breakthrough was recognized in 15 out of 16 cases (94%) on maps recorded with electrode arrays with inter-electrode distance of 1.25 and 2.5 cm. However, detectability of the breakthrough was reduced to 10 out of 16 cases (63%) with electrode array having inter-electrode distance of 5 cm. In conclusion, it is preferable to use an electrode array with an inter-electrode distance of no more than 2.5 cm for the purpose of breakthrough recognition.