Electrocardiographic analysis of ectopic atrial activity obscured by ventricular repolarization: P wave isolation using an automatic 62-lead QRST subtraction algorithm.
Electrocardiographic analysis of ectopic atrial activity obscured by ventricular repolarization: P wave isolation using an automatic 62-lead QRST subtraction algorithm.
复制标题
对心室复极掩盖的异位心房活动进行心电图分析：使用自动 62 导联 QRST 减法算法进行 P 波隔离。
DOI：
10.1046/j.1540-8167.2001.00780.x
复制
发表时间：
2001
影响因子：
2.7
通讯作者：
Lesh,MD
中科院分区：
文献类型：
--
作者：
Sippensgroenewegen,A;Mlynash,MD;Roithinger,FX;Goseki,Y;Lesh,MD
62导联QRST减影算法简介：早搏和室上性心律失常时体表心电图上的心房活动经常被前一个心动周期叠加的QRST波所掩盖。方法和结果：对12例患者(A组)和5例(B组)窦性心律和房性早搏、房性心动过速或阵发性房颤患者(A组)和5例(B组)患者进行62导联心电记录。A组患者以慢驱动周期进行起搏，以产生不被先前QRST复合波遮挡的异位P波，并以逐渐缩短的耦合间隔传递单次早搏刺激，以产生被T-U波的上坡分量(早期T-U波)、峰值(T-U波中段)和下坡分量(晚期T-U波)遮挡的异位P波。B组所有异位P波均被前一T-U波遮盖。根据窦性心律(A组和B组)或心房超速起搏(A组)时获得的平均QRST波群()构建自适应模板，实现QRST自动减影。随后对P波积分图进行了计算、直观比较和数学关联。A组患者()的“非隐匿”和“隐蔽”起搏P波积分图与B组患者(B组)相同房性心律失常形态的2~3个既往隐匿P波的空间标图具有较高的一致性。A组患者在T-U波早期()或晚期()而不是T-U波()(分别为早、中、晚、中)隐匿时，获得了更好的形态P波复制。结论：这种新的62导联QRST自动减影算法可以离散地分离体表心电图上隐蔽的T-U波，同时保留P波形态上复杂的空间细节。该算法的未来临床应用可能会改进阵发性心房颤动、房性心动过速和房性旁路的房性插入的心电图定位。
62‐Lead QRST Subtraction Algorithm.Introduction:Atrial activity on the surface ECG during premature beats and supraventricular arrhythmias frequently is obscured by the superimposed QRST complex of the previous cardiac cycle. This study examines the performance of a newly developed automatic QRST subtraction algorithm to isolate ectopic P waves from the preceding T‐U wave.Methods and Results:The 62‐lead ECG recordings were obtained during (1) sinus rhythm and programmed right atrial stimulation in 12 patients (group A); and (2) sinus rhythm and atrial premature beats, atrial tachycardia, or paroxysmal atrial fibrillation in 5 patients (group B). Pacing in group A patients was conducted at a slow drive cycle length to generate an ectopic P wave not obscured by the previous QRST complex and by delivering single premature extrastimuli at progressively shorter coupling intervals to produce an ectopic P wave obscured by the upsloping (early T‐U wave), peak (middle T‐U wave), and downsloping component of the T‐U wave (late T‐U wave). All ectopic P waves in group B patients were concealed by the preceding T‐U wave. Automatic QRST subtraction was attained using an adaptive template constructed from averaged QRST complexes () obtained during sinus rhythm (groups A and B) or atrial overdrive pacing (group A). P wave integral maps subsequently were computed, visually compared, and mathematically correlated. A high correspondence in spatial map pattern was observed between integral maps of “nonobscured” and previously “obscured” paced P waves obtained in group A patients () as well as between integral maps of two to three previously obscured P waves with the same atrial arrhythmia morphology obtained in group B patients (). Improved morphologic P wave replication in group A patients was acquired when concealment occurred in the early () or late part of the T‐U wave () as opposed to the middle T‐U wave () (for early vs middle and late vs middle T‐U wave, respectively).Conclusion:This novel automatic 62‐lead QRST subtraction algorithm enables discrete isolation of T‐U wave obscured ectopic atrial activity on the surface ECG while retaining the intricate spatial detail in P wave morphology. Future clinical application of the algorithm may enable improved ECG localization of focal triggers of paroxysmal atrial fibrillation, atrial tachycardia, and the atrial insertion of accessory pathways.