RECORDING FROM BODY-SURFACE OF ARRHYTHMOGENIC VENTRICULAR ACTIVITY DURING S-T SEGMENT
RECORDING FROM BODY-SURFACE OF ARRHYTHMOGENIC VENTRICULAR ACTIVITY DURING S-T SEGMENT
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DOI：
10.1016/0002-9149(78)90820-2
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发表时间：
1978-01-01
影响因子：
2.8
通讯作者：
LAZZARA, R
中科院分区：
文献类型：
--
作者：
BERBARI, EJ;SCHERLAG, BJ;LAZZARA, R
最近的实验报告已经证明，由于梗死，心外膜电位延迟超过QRS波群，延迟的程度与室性心律失常的发作直接相关。本文介绍了一种采用高放大、带通滤波和信号平均的方法，从体表记录这些预测室性心律失常的延迟电位。该技术已被用于记录被噪声掩蔽的低水平心脏电位。在10条狗上，分别记录了窦性心律、心房起搏和房性早搏时的心电图和体表平均导联。随后，结扎每只犬的冠状动脉左前降支。9只狗在手术过程中存活，并在梗死后3至6天进行了类似的记录。心电图变化与最近的梗死一致。在起搏方案期间，在7只狗中观察到表面平均电极导线的ST段出现离散的多相波形，并观察到QRS波群末端部分的伴随变化。在其中5只犬中，在更快的起搏频率下或在紧密耦合的房性早搏后观察到室性心律失常。然后重新打开胸部，并在使用多触点双极电极记录直接心外膜电描记图期间重复起搏程序。该电描记图验证了除一只犬外的所有犬的S-T段期间存在电位，并且在另一只犬中，晚期活动在逐搏基础上不可重复。因此，当通过心外膜电描记图确认晚期活动时，8只犬中有7只犬的表面平均导联出现相应变化。这项技术可能被证明是室性心律失常前异常电活动的敏感指标。
Recent experimental reports have documented the delay of epicardial potentials beyond the QRS complex as a result of infarction, and the degree of delay was directly associated with the onset of ventricular arrhythmias. This study describes a method using high amplification, band pass filtering and signal averaging for recording from the body surface these delayed potentials presaging ventricular arrhythmias. This technique, has been used for recording low level cardiac potentials masked by noise. In 10 dogs control records of the electrocardiogram and surface averaged lead were obtained during sinus rhythm, atrial pacing and premature atrial beats. Subsequently, the left anterior descending coronary artery was ligated in each dog. Nine dogs survived the surgical procedure and underwent similar recordings 3 to 6 days after infarction. Electrocardiographic changes were consistent with a recent infarction. During the pacing protocol discrete multiphasic wave forms appeared during the S-T segment of the surface averaged lead, and concomitant changes in the terminal portions of the QRS complex were observed in seven dogs. In five of these dogs ventricular arrhythmias were observed at the faster pacing rates or after closely coupled premature atrial beats. The chest was then reopened and the pacing procedure repeated during recording of direct epicardial electrograms with a multicontact bipolar electrode. This electrogram validated the existence of potentials during the S-T segment in all but one dog and late activity that was not repeatable on a beat to beat basis in another. Thus, when late activity was confirmed with the epicardial electrogram, seven of eight dogs showed a corresponding change in the surface averaged lead. This technique may prove to be a sensitive indicator of abnormal electrical activity preceding ventricular arrhythmias.