INTRAOPERATIVE ENDOCARDIAL MAPPING DURING SINUS RHYTHM - RELATIONSHIP TO SITE OF ORIGIN OF VENTRICULAR-TACHYCARDIA
INTRAOPERATIVE ENDOCARDIAL MAPPING DURING SINUS RHYTHM - RELATIONSHIP TO SITE OF ORIGIN OF VENTRICULAR-TACHYCARDIA
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DOI：
10.1161/01.cir.70.6.957
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发表时间：
1984-01-01
期刊：
影响因子：
37.8
通讯作者：
JOSEPHSON, ME
中科院分区：
文献类型：
--
作者：
KIENZLE, MG;MILLER, J;JOSEPHSON, ME
定位引导的心内膜切除术已被证明是治疗复发性持续性室性心动过速的有效方法。然而，有些患者无法在室性心动过速期间进行定位，因此从正常窦性心律的结果中获得指导是非常可取的。在窦性心律期间检查心内膜记录的几种异常类型的心电图的频率、时间和持续时间，这些发现与持续室性心动过速期间的激活映射有关。在窦性心律和诱发性室性心动过速的术中，对广泛心肌梗死合并复发性持续性室性心动过速的患者（13例）进行了涉及整个心内膜表面的标准化制图方案的研究。所有患者均记录分步电图（多分量，振幅< 1mv，持续时间bbb50 ms）。这种类型的电图可以在多达36%的地图上记录下来。分裂电图（由等电周期分离的2个分量）也经常出现，但仅涉及平均5.8%的映射位点。晚期电图（完全在QRS复合体之后绘制）仅在13例患者中的4例中记录在平均5%的绘制位点上。这些心电图的位置与室性心动过速时记录的心内膜最早激活部位周围任意8平方厘米的区域有关。最长分段电图与22种室性心动过速形态中的9种密切相关，最长分段电图与16种形态中的7种密切相关，最长分段电图与4种形态中的2种密切相关。在广泛的心肌梗死合并室性心动过速的患者中，在窦性心律期间记录的心内膜异常心电图非常普遍。这些心电图可能与室性心动过速的起源部位有关，但不是特定的。基于这些心电图类型的窦性心律映射的外科手术可能比在室性心动过速期间由心内膜激活引导的手术更广泛。
Mapping-guided endocardial resection has proved to be an effective therapy for recurrent sustained ventricular tachycardia. However, some patients cannot be mapped during ventricular tachycardia, so that guidance from findings during normal sinus rhythm would be highly desirable. The frequency, timing and duration of several abnormal types of electrograms recorded endocardially were examined during sinus rhythm and these findings were related to activation mapping during sustained ventricualr tachycardia. Patients (13) with extensive myocardial infarction complicated by recurrent sustained ventricular tachycardia were studied intraoperatively during sinus rhythm and induced ventricular tachycardia with a standardized mapping scheme involving the entire endocardial surface. Fractionated electrograms (multicomponent with amplitude < 1 mV and duration > 50 ms) were recorded in all patients. This type of electrogram could be recorded at up to 36% of mapped sites. Split electrograms (2 components separated by isoelectric period) were also frequently seen but involved only a mean of 5.8% of mapped sites. Late electrograms (inscribed entirely after the QRS complex) were only recorded in 4 of 13 patients at a mean of 5% of mapped sites. The location of these electrograms was related to an arbitrary 8 cm2 zone around the earliest site to endocardial activation recorded during ventricular tachycardia. The longest fractionated electrogram was closely related to 9 of 22 morphologies of induced ventricular tachycardia, split electrograms were related to 7 of 16 morphologies, and late electrograms to 2 of 4 morphologies. Extremely abnormal electrograms recorded endocardially during sinus rhythm are widespread in patients with extensive myocardial infarction complicated by ventricular tachycardia. These electrograms may be associated with, but are not specific for, sites of origin of ventricular tachycardia. Surgical procedures based on sinus rhythm mapping of these electrogram types would likely result in more extensive surgical excision than those guided by endocardial activation during ventricular tachycardia.