Simultaneous computer mapping to facilitate intraoperative localization of accessory pathways in patients with Wolff-Parkinson-White syndrome.
Simultaneous computer mapping to facilitate intraoperative localization of accessory pathways in patients with Wolff-Parkinson-White syndrome.
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同步计算机绘图有助于沃尔夫-帕金森-怀特综合征患者术中旁路定位。
DOI：
10.1016/0002-9149(85)91012-4
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Cain,ME
中科院分区：
文献类型：
--
作者：
Kramer,JB;Corr,PB;Cox,JL;Witkowski,FX;Cain,ME
16例Wolff-Parkinson-白色综合征患者在手术分离旁道前接受了多个部位的同时术中计算机标测。将16双极电极带定位在房室沟周围。在心房起搏期间同时记录单次搏动的心室心外膜电图，从而产生最大预激，并在顺向性室上性心动过速期间记录心房电图。3例患者同时使用了四节段透壁穿刺针电极。使用保护信号调节器单独处理电描记图，该信号调节器以2 kHz的12位精度同步隔离、放大、滤波和模数转换。数字数据通过光纤传输到高密度数字记录器，并由具有快速交互图形的计算机进行处理。16例患者的结果显示20个不同的肯特束。2例仅术中诱发非持续性室上性心动过速，1例表现为间歇性室性前向阵发性室性预激。在4例患者中确定了多个途径。这种同时多电极标测程序通过仅需要单次搏动来分析顺行和逆行激动时间而促进术中标测，减少了标测期间的心脏操作，避免了对心肺转流的需要，并允许分析透壁激动模式。这种方法显着减少标测所需的时间，并允许准确研究非持续性心律失常以及快速识别多个旁道。
Sixteen patients with the Wolff-Parkinson-White syndrome underwent simultaneous intraoperative computer mapping from multiple sites before surgical division of the accessory pathways. A 16-bipolar electrode band was positioned around the atrioventricular groove. Ventricular epicardial electrograms from single beats were recorded simultaneously during atrial pacing, resulting in maximal preexcitation, and atrial electrograms were recorded during orthodromic supraventricular tachycardia. Four-level transmural plunge needle electrodes were used concomitantly in 3 patients. Electrograms were processed separately using a guarded signal conditioner that isolates, amplifies, filters and analog-to-digitally converts synchronously at 2 kHz with 12-bit accuracy. Digital data were transmitted by fiber optics to a high-density digital recorder and processed with a computer having rapid interactive graphics. Results in the 16 patients revealed 20 distinct Kent bundles. Two patients had only nosustained supraventricular tachycardia induced intraoperatively and 1 patient manifested intermittent anterograge ventricular preexcitation. Multiple pathways were identified in 4 patients. This simultaneous multiple electrode mapping procedure facilitates intraoperative mapping by requiring only a single beat for analysis of anterograde and retrograde activation times, decreases cardiac manipulation during mapping and obviates the need for cardiopulmonary bypass, and permits analysis of transmural activation patterns. This approach decreases markedly the time required for mapping and permits accurate study of nonsustained arrhythmias as well as rapid identification of multiple accessory pathways.