Computer-assisted intraoperative mapping of the entire ventricular epicardium in the Wolff-Parkinson-White syndrome.
Computer-assisted intraoperative mapping of the entire ventricular epicardium in the Wolff-Parkinson-White syndrome.
复制标题
沃尔夫-帕金森-怀特综合征整个心室外膜的计算机辅助术中测绘。
DOI：
10.1016/s0002-9149(86)80016-9
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Ideker,RE
中科院分区：
文献类型：
--
作者：
VidailletJr,HJ;Lowe,JE;German,LD;Chen,PS;Greer,GS;Gilbert,MR;Smith,WM;Worley,SJ;Ideker,RE
术中使用手持式漫游电极测图需要持续5到10分钟的节奏。为了克服这一限制，研究人员使用了一种计算机化制图系统，该系统同时记录了60个心外膜电极的数据，并对16名沃尔夫-帕金森-怀特综合征患者进行了研究。在脑室上方放置一个包含6排电极的袜子，从基部到顶点呈同心排列。从放置袜子到分析最基础的电极记录的总时间为5分钟。然后将一个包含56个电极的39 × 44毫米斑块放置在房室（AV）沟槽上，通过最底部的袜子电极行识别出的预兴奋区域，对心室和心房进行详细的同时测绘。在斑块放置和记录期间，分析剩余的袜子记录并绘制完整的等时心外膜图。然后分析斑块记录。这项技术可以快速检测到AV凹槽的早期激活，就像其他计算机系统一样，只需在AV凹槽周围使用一组电极。此外，完整的心外膜测图提供了重要的附加信息。1例有后隔旁副通路的患者在AV波段记录的心外膜下有室性突破。当超过1个早期激活位点沿AV沟存在时，完整的图谱允许从束分支上升的正常激活锋中区分出多条通路。完整的心外膜图可以研究快速变化或短暂的电事件，包括孤立的过早脉冲、起搏引起的往复式心动过速的开始和终止、往复式心动过速期间起搏引起的夹带和融合程度的变化，以及房颤期间的心室反应。因此，与手持式探针测绘和仅使用AV电极带的计算机测绘相比，计算机辅助测绘整个心室心外膜具有特定的优势。
Intraoperative mapping with a hand-held, roving electrode requires a sustained rhythm lasting 5 to 10 minutes. To overcome this limitation, a computerized mapping system that records from 60 epicardial electrodes simultaneously was used to study 16 patients with Wolff-Parkinson-White syndrome. A sock containing 6 rows of electrodes arranged concentrically from base to apex was placed over the ventricles. The total time from placing the sock to analyzing the most basal row of electrode recordings was 5 minutes. A 39 × 44-mm plaque containing 56 electrodes was then placed across the atrioventricular (AV) groove for detailed simultaneous mapping of the ventricle and atrium in the preexcited region identified from the most basal row of sock electrodes. During plaque placement and recording, the remaining sock recordings were analyzed and a complete isochronal epicardial map was drawn. The plaque recordings were then analyzed. This technique rapidly detects early activation at the AV groove as do other computer systems using only a band of electrodes around the AV groove. Also, complete epicardial mapping supplied important additional information. One patient with a posterior paraseptal accessory pathway had ventricular epicardial breakthrough below the strip recorded by the AV band. When more than 1 early activation site was present along the AV groove, complete maps allowed multiple pathways to be differentiated from normal activation fronts ascending from the bundle branches. Complete epicardial maps allowed the study of rapidly changing or short-lived electrical events including isolated premature impulses, initiation and termination of reciprocating tachycardia by pacing, entrainment and changing degrees of fusion created by pacing during reciprocating tachycardia, and ventricular responses during atrial fibrillation. Thus, computer-assisted mapping of the entire ventricular epicardium offers specific advantages over both hand-held probe mapping and computer mapping using only an AV band of electrodes.