AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part IV: The ST Segment, T and U Waves, and the QT Interval A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology
AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part IV: The ST Segment, T and U Waves, and the QT Interval A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology
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DOI：
10.1016/j.jacc.2008.12.014
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发表时间：
2009-03-17
影响因子：
24
通讯作者：
Gettes, Leonard S.
中科院分区：
文献类型：
--
作者：
Rautaharju, Pentti M.;Surawicz, Borys;Gettes, Leonard S.
本文是6篇系列文献中的第四篇，重点是为心电图（ECG）的标准化和解释提供当前指南。该项目由美国心脏协会临床心脏病学理事会发起。该项目的基本原理及其实施过程已在前面描述（1）。ST段、T波和QT间期的异常反映了心室复极的异常。这些异常是常见的，往往难以解释。U波很可能代表复极化完成后发生的一种电-机械现象。然而，它经常被包括在复极的讨论中，并在本节中讨论。ST段对应于心室跨膜动作电位的平台期。在正常情况下，跨膜电压在此阶段缓慢变化，并在所有心室心肌细胞中保持大致相同的水平。结果，仅存在小的电压梯度。这种明显的电压梯度的缺乏类似于在电复极化期间发生的情况，即从复极化结束到下一次去极化开始，当心室心肌细胞处于约85 mV的静息跨膜电位时。这对应于ECG上的TP段。在心动周期的这两个阶段，心室心肌细胞中没有明显的电压梯度，这解释了为什么ST段和TP段通常几乎平坦，并且处于大致相同的水平;也就是说，它们是等电的。T波对应于心室动作电位的快速心室复极的阶段（阶段3）。
The present article is the fourth in a series of 6 documents focused on providing current guidelines for the standardization and interpretation of the electrocardiogram (ECG). The project was initiated by the Council on Clinical Cardiology of the American Heart Association. The rationale for this project and the process for its implementation were described earlier (1). Abnormalities in the ST segment, T wave, and duration of the QT interval reflect abnormalities in ventricular repolarization. These abnormalities are common and often difficult to interpret. The U wave most likely represents an electricmechanical phenomenon that occurs after repolarization is completed. However, it is frequently included in discussions of repolarization and is discussed in this section. The ST segment corresponds to the plateau phase of the ventricular transmembrane action potential. Under normal conditions, the transmembrane voltage changes slowly during this phase and remains at approximately the same level in all ventricular myocardial cells. As a result, only small voltage gradients are present. This absence of pronounced voltage gradients is similar to that which occurs during electric diastole, that is, from the end of repolarization to the onset of the next depolarization, when ventricular myocardial cells are at their resting transmembrane potential of approximately 85 mV. This corresponds to the TP segment on the ECG. The absence of significant voltage gradients in ventricular myocardial cells during these 2 phases of the cardiac cycle explains why the ST and TP segments are normally nearly flat and at approximately the same level; that is, they are isoelectric. The T wave corresponds to the phase of rapid ventricular repolarization (phase 3) of the ventricular action potential.