Quantifying the Spatiotemporal Influence of Acute Myocardial Ischemia on Volumetric Conduction Speeds.

Acute myocardial ischemia compromises the ordered electrical activation of the heart, however, because of sampling limitations, volumetric changes in activation have not been measured. We used a large-animal experimental model and high-resolution volumetric mapping to study the effects of ischemia on conduction speeds (CS) throughout the myocardium. We estimated CS and electrocardiographic changes (ST segments) and evaluated the spatial and temporal correlations between them across 11 controlled episodes. We found that ischemia induces significant conduction slowing, reducing the global median speed by 25 cm/s. Furthermore, there was a high temporal correlation between the development of ischemic severity and CS (corr. = 0.93) through each episode. The spatial correlations between ST-segment changes and CS slowing were more spatially complex than expected with substantial slowing at the periphery of the zones that showed ST-segment changes. This is the first study that has documented in an experimental model volumetric changes of CS during acute myocardial ischemia and explored the relationships between ischemia development in space and time. We showed that conduction speed changes are spatiotemporally correlated to ischemic severity and illustrated the biphasic response long proposed from cellular studies.