In vivo electrophysiological detection of myocardial ischemia through monophasic action potential recording.

D ETECTION OF myocardial ischemia by biochemical, mechanical, or electrocardiographic assessment is limited by the fact that one cannot determine the precise region that is affected by reduction of blood flow. This is especially true of the electrophysiological manifestations of ischemia since the initial changes that occur in a small area of myocardium are not indicated by the electrocardiogram (ECG). However, these changes are important because they are involved in the genesis of lethal cardiac arrhythmias. This article will review the evidence that monophasic action potential (MAP) recordings are sensitive to changes in the cellular electrophysiological properties of ischemic myocardium and that they can specifically localize the ischemic zone. The use of the MAP electrode clinically may permit the localization of changes in electrical activity resulting from disease. Additionally, the mechanisms underlying changes in MAP recordings during ischemia will be discussed. To understand the possible cellular mechanisms underlying ischemia-induced changes in MAPS requires a brief review of the cellular electrophysiological changes that are known to occur during ischemia.le3

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