Body surface mapping of counterclockwise and clockwise typical atrial flutter: a comparative analysis with endocardial activation sequence mapping.
Body surface mapping of counterclockwise and clockwise typical atrial flutter: a comparative analysis with endocardial activation sequence mapping.
复制标题
逆时针和顺时针典型心房扑动的体表测绘：与心内膜激活序列测绘的比较分析。
DOI：
10.1016/s0735-1097(00)00549-0
复制
发表时间：
2000
影响因子：
24
通讯作者：
Scheinman,MM
中科院分区：
文献类型：
--
作者：
SippensGroenewegen,A;Lesh,MD;Roithinger,FX;Ellis,WS;Steiner,PR;Saxon,LA;Lee,RJ;Scheinman,MM
本研究旨在发展空间62导联心电图（ECG）标准，用于有和无结构性心脏病患者的逆时针（CCW）和顺时针（CW）典型心房扑动（FI）的分类。方法对12例CCW型典型房性F1、3例CW型典型F1、4例两型典型F1、1例CCW型和不典型房性F1患者的62个躯干部位进行心电图和多点心内膜描记。所有的F1波发作被分成两个或三个连续的时间段，显示稳定的电位分布，从中计算积分图。1）右房间隔的尾侧激活和近端至远端冠状窦激活，2）右房游离壁的头尾侧激活，3）激活咽鼓管下峡部外侧部。初始、中间和终末CW FI波图模式分别对应于：1）头尾侧右房间隔激动，2）咽鼓管下峡部激动和近端至远端冠状窦激动，以及3）尾侧右房游离壁激动。在建立了高度定量的患者间积分图模式对应关系后，计算了三个连续FI波周期的典型CCW和CW平均积分图的参考集，而不管是否存在器质性心脏病。人的CCW和CW典型心房F1的导联ECG的特征在于刻板的空间电压分布，其可以直接与潜在的激活序列，并且对F1波旋转的方向具有高度特异性。平均CCW和CW Fl波积分标测图为改善典型心房Fl的临床检测和分类提供了独特的参考集。
OBJECTIVESThis study was directed at developing spatial 62-lead electrocardiogram (ECG) criteria for classification of counterclockwise (CCW) and clockwise (CW) typical atrial flutter (Fl) in patients with and without structural heart disease.BACKGROUNDElectrocardiographic classification of CCW and CW typical atrial Fl is frequently hampered by inaccurate and inconclusive scalar waveform analysis of the 12-lead ECG.METHODSElectrocardiogram signals from 62 torso sites and multisite endocardial recordings were obtained during CCW typical atrial Fl (12 patients), CW typical Fl (3 patients), both forms of typical Fl (4 patients) and CCW typical and atypical atrial Fl (1 patient). All the Fl wave episodes were divided into two or three successive time periods showing stable potential distributions from which integral maps were computed.RESULTSThe initial, intermediate and terminal CCW Fl wave map patterns coincided with: 1) caudocranial activation of the right atrial septum and proximal-to-distal coronary sinus activation, 2) craniocaudal activation of the right atrial free wall, and 3) activation of the lateral part of the subeustachian isthmus, respectively. The initial, intermediate and terminal CW Fl wave map patterns corresponded with : 1) craniocaudal right atrial septal activation, 2) activation of the subeustachian isthmus and proximal-to-distal coronary sinus activation, and 3) caudocranial right atrial free wall activation, respectively. A reference set of typical CCW and CW mean integral maps of the three successive Fl wave periods was computed after establishing a high degree of quantitative interpatient integral map pattern correspondence irrespective of the presence or absence of organic heart disease.CONCLUSIONSThe 62-lead ECG of CCW and CW typical atrial Fl in man is characterized by a stereotypical spatial voltage distribution that can be directly related to the underlying activation sequence and is highly specific to the direction of Fl wave rotation. The mean CCW and CW Fl wave integral maps present a unique reference set for improved clinical detection and classification of typical atrial Fl.