Basic Science for the Clinical Electrophysiologist The Pathophysiologic Basis of Fractionated and Complex Electrograms and the Impact of Recording Techniques on Their Detection and Interpretation
Basic Science for the Clinical Electrophysiologist The Pathophysiologic Basis of Fractionated and Complex Electrograms and the Impact of Recording Techniques on Their Detection and Interpretation
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临床电生理学家的基础科学 分段和复杂电图的病理生理学基础以及记录技术对其检测和解释的影响
DOI：
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
F. Wittkampf
中科院分区：
文献类型：
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作者：
F. Wittkampf
直接从心脏记录的细胞外电信号是侵入性心脏电生理学的标志，并提供有关潜在心肌电状态的信息。这些心电图是由心肌细胞的去极化产生的，它在细胞外空间产生跨膜电流，并由于细胞外介质的电阻而产生电位差。在健康心肌中，细胞外电信号的基本构型很简单。然而，在病理条件下，心电图可能由多个成分组成，持续时间长，这被认为是由于异常传导和心律失常所致。虽然复杂和分离的电信号目前被认为是一种真实的现象，但在大约20年前并不是这样。关于复杂和分段心电的“伪影”的争论很常见。1当时，在心内膜标测期间，治愈的心肌梗死患者被记录到由多个幅度低、持续时间长的“高频”成分组成的心电图样。一些研究人员推测，分离的心电图是由电极和心肌之间的运动、放大器的滤波特性或代表远场效应引起的伪影。支持“伪像理论”的一个经典例子是记录水母脑中的连续活动。2在那个时代，人们非常关注治愈的心肌梗死中的分段心电图，以指导导管消融或抗心律失常手术。3-5虽然伪像确实可能导致复杂的心电图，但大多数复杂和分段的心电图是一个事实，由激活前沿的特殊行为引起，这是由于潜在心肌的结构和电的复杂性。本文概述了单极细胞外电信号的起源，回顾了产生分离和复杂电信号的情况，并讨论了记录技术对多方面电信号检测和解释的影响。
Extracellular electrograms, recorded directly from the heart, are the hallmarks of invasive cardiac electrophysiology and provide information about the electric status of the underlying myocardium. These electrograms are generated by depolarization of cardiomyocytes that generates transmembrane currents in extracellular space and potential differences due to electric resistance of the extracellular medium. In healthy myocardium, the basic configuration of the extracellular electrogram is simple. Under pathological conditions, however, electrograms may consist of multiple components and long duration, which have been attributed to abnormal conduction and arrhythmogenicity. Although complex and fractionated electrograms are presently considered to be a real phenomenon, this was not the case some 20 years ago. Debates about the “fact or artifact” of complex and fractionated electrograms were common.1 At that time, electrograms consisting of multiple “high frequency” components with low amplitudes and long duration, termed “fractionated,” were recorded in patients with healed myocardial infarction during endocardial mapping. Several investigators presumed that fractionated electrograms were artifacts, resulting from movements between electrode and myocardium, filter characteristics of amplifiers, or represented far field effects. A classic example to support the “artifact theory” was the recording of continuous activity from the jello brain.2 In those days, much attention had been paid to fractionated electrograms in healed myocardial infarction to guide catheter ablation or antiarrhythmic surgery.3–5 Although artifacts indeed may cause complex electrograms, most of the complex and fractionated electrograms are a “fact” and caused by the peculiar behavior of activation fronts, due to structural and electric complexity of the underlying myocardium. This article delineates the origin of the unipolar extracellular electrogram, reviews the circumstances that cause fractionated and complex electrograms, and discusses the impact of the recording technique on detection and interpretation of multifaceted electrograms.
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影响因子：
5.5
作者：
Spach, Madison S.;Heidlage, J. Francis;Barr, Roger C.
通讯作者：
Barr, Roger C.
复杂分数的起源是在缓慢传导区域中的心房电图：微纤维化的计算机模型。
影响因子：
5.5
作者：
Jacquemet, Vincent;Henriquez, Craig S.
通讯作者：
Henriquez, Craig S.
利用右心室隔离程序的动物模型中远距离电位对单极电图的影响。
影响因子：
24
作者：
DamianoJr,RJ;Blanchard,SM;Asano,T;Cox,JL;Lowe,JE
通讯作者：
Lowe,JE
确定局部心肌电激活以进行激活序列映射。
影响因子：
20.1
作者：
Anderson,KP;Walker,R;Ershler,PR;Fuller,M;Dustman,T;Menlove,R;Karwandee,SV;Lux,RL
通讯作者：
Lux,RL
DOI：
10.1016/0002-9149(82)90296-x
发表时间：
1982
期刊：
The American journal of cardiology
影响因子：
--
作者：
Gallagher,JJ;Kasell,JH;Cox,JL;Smith,WM;Ideker,RE;Smith,WM
通讯作者：
Smith,WM