A fourth criterion for transient entrainment: the electrogram equivalent of progressive fusion.
A fourth criterion for transient entrainment: the electrogram equivalent of progressive fusion.
复制标题
瞬时夹带的第四个标准：渐进融合的电描记图等效值。
DOI：
10.1161/01.cir.77.5.1003
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发表时间：
1988
期刊：
影响因子：
37.8
通讯作者：
Waldo,AL
中科院分区：
文献类型：
--
作者：
Henthorn,RW;Okumura,K;Olshansky,B;Plumb,VJ;Hess,PG;Waldo,AL
先前有关瞬态夹带和相关现象的数据可以通过重入电路的起搏捕获得到最好的解释。在此基础上，我们假设从两个不同的恒定起搏速率的单一部位进行快速起搏，可以在以一种速率起搏时，从一个方向以恒定的刺激-电图间隔不断捕获适当选择的双极电图记录部位，而在以不同的恒定起搏速率起搏时，从另一个方向以不同的恒定刺激-电图间隔不断捕获。为了验证这一假设，我们研究了一组患者，每个患者都有代表性的心动过速（室性心动过速、涉及房室旁路的马戏心动过速、房性心动过速和心房扑动）。对于每个心动过速，起搏从一个部位进行，至少两个不同的恒定速率比心动过速的自发速率快。我们在这些患者中观察到，以两种不同的起搏速率从不同方向不断捕获局部双极记录位点，而在起搏终止时没有中断心动过速。在两种不同的起搏速率下，从不同的方向捕捉到同一部位的证据得到了支持，当比较每种起搏速率时，该部位的传导时间变化与该部位的双极电图形态学变化相关。起搏时平均周期长度为265 +/- 50毫秒，平均传导时间（刺激到记录部位电图间隔）为319 +/- 69毫秒，而起搏时平均周期长度为233 +/- 51毫秒，平均传导时间变化为238 +/- 56毫秒。值得注意的是，更快的起搏速率导致更短的传导时间。同一电极记录位点在起搏终止时从不同方向被激活而没有中断自发性心动过速的事实，除了重新进入外，很难从任何机制基础上解释。此外，这些传导时间和电图形态学的变化与心电图上的渐进式融合搏动同时发生，后者是短暂性夹带的既定标准。（摘要删节为400字）
Prior data pertaining to transient entrainment and associated phenomena have been best explained by pacing capture of a reentrant circuit. On this basis, we hypothesized that rapid pacing from a single site of two different constant pacing rates could constantly capture an appropriately selected bipolar electrogram recording site from one direction with a constant stimulus-to-electrogram interval during pacing at one rate, yet be constantly captured from another direction with a different constant stimulus-to-electrogram interval when pacing at a different constant pacing rate. To test this hypothesis, we studied a group of patients, each with a representative tachycardia (ventricular tachycardia, circus-movement tachycardia involving an atrioventricular bypass pathway, atrial tachycardia, and atrial flutter). For each tachycardia, pacing was performed from a single site for at least two different constant rates faster than the spontaneous rate of the tachycardia. We observed in these patients that a local bipolar recording site was constantly captured from different directions at two different pacing rates without interrupting the tachycardia at pacing termination. The evidence that the same site was captured from a different direction at two different pacing rates was supported by demonstrating a change in conduction time to that site associated with a change in the bipolar electrogram morphology at that site when comparing pacing at each rate. The mean conduction time (stimulus-to-recording site electrogram interval) was 319 +/- 69 msec while pacing at a mean cycle length of 265 +/- 50 msec, yet only 81 +/- 38 msec while pacing at a second mean cycle length of 233 +/- 51 msec, a mean change in conduction time of 238 +/- 56 msec. Remarkably, the faster pacing rate resulted in a shorter conduction time. The fact that the same electrode recording site was activated from different directions without interruption of the spontaneous tachycardia at pacing termination is difficult to explain on any mechanistic basis other than reentry. Also, these changes in conduction time and electrogram morphology occurred in parallel with the demonstration of progressive fusion beats on the electrocardiogram, the latter being an established criterion for transient entrainment.(ABSTRACT TRUNCATED AT 400 WORDS)