A novel lead configuration for optimal spatio-temporal detection of intracardiac repolarization alternans.
A novel lead configuration for optimal spatio-temporal detection of intracardiac repolarization alternans.
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DOI：
10.1161/circep.109.934208
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发表时间：
2011-06
期刊：
影响因子：
--
通讯作者：
Armoundas AA
中科院分区：
文献类型：
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作者：
Weiss EH;Merchant FM;d'Avila A;Foley L;Reddy VY;Singh JP;Mela T;Ruskin JN;Armoundas AA
电交替是每隔一次心跳发生的心电图波形形状的变化模式。在人类中，心室复极的交替（称为复极交替（RA））与室性心动过速/颤动和心脏性猝死的易感性增加有关。本研究探讨了猪急性心肌缺血模型心内RA的时空变异性及其与体表RA的关系。我们开发了一个实时多通道复极信号采集、显示和分析系统，用于记录回旋支冠状动脉球囊闭塞前后右心室、冠状窦、左心室和心外膜表面导管的心电图信号。我们发现RA在缺血发作后4分钟内可检测到，并且在复极间期的前半段最明显。在单极和双极电极导线（近场和远场配置）和体表电极导线上均可检测到缺血诱导的RA。远场双极心内电极导线对RA检测比体表电极导线更敏感，体表RA检测的概率随着心内电极导线检测RA数量的增加而增加，当至少3个心内电极导线检测到RA时，接近100%。我们基于跨越右心室（RV）和冠状窦（CS）导管的电极导线三角形排列开发了一种新型临床适用心内电极导线系统，与任何其他远场双极感知配置相比，该系统为心内RA检测提供了最高灵敏度（p < 0.0001）。总之，心内电交替是一种与心律失常易感性和心源性猝死相关的复杂时空现象，可通过新型三角形RV-CS电极导线配置可靠检测。
Electrical alternans is a pattern of variation in the shape of electrocardiographic waveform that occurs every other beat. In humans, alternation in ventricular repolarization, known as repolarization alternans (RA), has been associated with increased vulnerability to ventricular tachycardia/fibrillation and sudden cardiac death. This study investigates the spatio-temporal variability of intracardiac RA and its relationship to body surface RA in an acute myocardial ischemia model in swine. We developed a real-time multi-channel repolarization signal acquisition, display and analysis system to record electrocardiographic signals from catheters in the right ventricle, coronary sinus, left ventricle, and epicardial surface prior to and following circumflex coronary artery balloon occlusion. We found that RA is detectable within 4 minutes following the onset ischemia, and is most prominently seen during the first half of the repolarization interval. Ischemia-induced RA was detectable on unipolar and bipolar leads (both in near- and far-field configurations) and on body surface leads. Far-field bipolar intracardiac leads were more sensitive for RA detection than body surface leads, with the probability of body surface RA detection increasing as the number of intracardiac leads detecting RA increased, approaching 100% when at least three intracardiac leads detected RA. We developed a novel, clinically-applicable intracardiac lead system based on a triangular arrangement of leads spanning the right ventricular (RV) and coronary sinus (CS) catheters which provided the highest sensitivity for intracardiac RA detection when compared to any other far-field bipolar sensing configurations (p < 0.0001). In conclusion, intracardiac alternans, a complex spatio-temporal phenomenon associated with arrhythmia susceptibility and sudden cardiac death, can be reliably detected through a novel triangular RV-CS lead configuration.