Determination of local myocardial electrical activation for activation sequence mapping. A statistical approach.
Determination of local myocardial electrical activation for activation sequence mapping. A statistical approach.
复制标题
确定局部心肌电激活以进行激活序列映射。
DOI：
10.1161/01.res.69.4.898
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发表时间：
1991
影响因子：
20.1
通讯作者：
Lux,RL
中科院分区：
文献类型：
--
作者：
Anderson,KP;Walker,R;Ershler,PR;Fuller,M;Dustman,T;Menlove,R;Karwandee,SV;Lux,RL
电激活序列标测需要准确识别局部激活，但由于细胞外记录并不完全反映局部事件，因此可能难以解释复杂的电描记图。在这种情况下，局部激活的分配容易出现错误，这可能会影响对所得激活图的解释。本研究的目的是开发一种方法，将提供定量指标的错误，在确定本地激活。在心脏直视手术期间，使用具有64个紧密间隔的单极电极的电极阵列从左心室表面记录。记录了4例瘢痕心肌患者的多个偏转的电描记图;另外2例心肌功能正常的患者作为对照。784个偏转中的每一个都根据三个特征进行评分：传播的证据、双极信号的配置以及从胸部到平均参考的变化的影响。如果存在所有三个特征的证据，则认为局部激活是可能的，如果三个特征都不存在，则认为不太可能。排除了与本标准不明确的偏转。在分析的30多个测试变量中，区分局部激活信号与远端活动信号的能力最强的三个变量是：1）细胞外电位加上二阶导数与细胞外电位之比的线性组合，2）二阶导数，以及3）最小（最大负）一阶导数。对于这些变量中的每一个，提供最大性能的阈值被确定为最高质量的效率，一个指标的协议。这种统计方法提供了一个客观的基础，确定局部激活，并提供了一个定量评估的错误，可以提高解释的电激活序列图。
Electrical activation sequence mapping requires accurate identification of local activation, but because extracellular recordings do not exclusively reflect local events, complex electrograms may be difficult to interpret. In such cases, the assignment of local activation is subject to error that could affect interpretation of the resulting activation maps. The purpose of this investigation was to develop an approach that would provide quantitative indexes of error in the determination of local activation. An electrode array with 64 closely spaced unipolar electrodes was used to record from the left ventricular surface during open heart surgery. Electrograms with multiple deflections were recorded from four patients with scarred myocardium; two other patients with normal myocardial function served as controls. Each of 784 deflections was scored on the basis of three features: evidence for propagation, the configuration of the bipolar signal, and the effect of changing from the chest to an average reference. Local activation was considered probable if evidence for all three features was present and improbable if none of the three features was present. Deflections that were ambiguous with respect to this standard were excluded. Of over 30 test variables analyzed, the three with the greatest power to discriminate signals due to local activation from those due to distant activity were 1) a linear combination of the extracellular potential plus the ratio of the second derivative and the extracellular potential, 2) the second derivative, and 3) the minimum (greatest negative) first derivative. For each of these variables, the threshold value providing the greatest performance was identified by the maximum quality of efficiency, an index of agreement. This statistical approach provides an objective basis for determining local activation and provides a quantitative assessment of error that could enhance interpretation of electrical activation sequence maps.