Fractionated electrograms in dilated cardiomyopathy: Origin and relation to abnormal conduction
Fractionated electrograms in dilated cardiomyopathy: Origin and relation to abnormal conduction
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DOI：
10.1016/0735-1097(95)00612-5
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发表时间：
1996-04-01
影响因子：
24
通讯作者：
Lahpor, JR
中科院分区：
文献类型：
--
作者：
deBakker, JMT;vanCapelle, FJL;Lahpor, JR
目标.我们试图研究碎裂电图的起源及其与心肌病性心肌传导异常的关系。扩张型心肌病患者室性心动过速的发生率较高。这些患者记录的电描记图往往是分散的。对7例扩张型心肌病心脏移植患者的11块灌注乳头肌和6块小梁进行了高分辨率电活动标测（电极间距离200 μ m）。在狗心脏的四个乳头肌中进行了类似的测量，其中人工制造了电屏障。对10例人体标本进行了组织学研究。所有的准备工作都显示了具有碎裂电描记图的部位。在三个人的准备，激活模式显示了一个可辨别的线的激活块平行于纤维方向。在与阻滞线相邻的部位记录部分电描记图。在五个准备，分馏电描记图记录在网站的线路块没有被确定。在这些制备物中，电屏障由短的纤维组织组成。在其余的9个准备工作中，仅记录了部分电描记图，既包括与明显障碍物相邻的部位，也包括没有障碍物证据的部位。我们的观察结果表明，心肌病损伤的心肌中记录到的碎裂电图是由于不同的长股和短伸展的纤维组织。延迟传导是由不同的阻滞线周围的激活曲线和短屏障之间的激活波形引起的。后者反映了极端不均匀的各向异性。
Objectives. We sought to investigate the origin of the fractionated electrogram and its relation to abnormal conduction in cardiomyopathic myocardium.Background. Patients with dilated cardiomyopathy have a high incidence of ventricular tachycardias. Electrograms recorded in these patients are often fractionated.Methods. High resolution mapping (200-mu m interelectrode distance) of the electrical activity was carried out in 11 superfused papillary muscles and 6 trabeculae from 7 patients who underwent heart transplantation because of dilated cardiomyopathy. Similar measurements were taken in four papillary muscles from dog hearts in which electrical barriers had been artificially made. Ten human preparations were studied histologically.Results. All preparations revealed sites with fractionated electrograms. In three human preparations, activation patterns showed a discernible line of activation block running parallel to the fiber direction. Fractionated electrograms were recorded at sites contiguous to the line of block. In five preparations, fractionated electrograms were recorded at sites where lines of block were not identified. In these preparations, electrical barriers consisted of short stretches of fibrous tissue. In the remaining nine preparations, fractionated electrograms mere recorded, both from sites contiguous to distinct obstacles and sites without evidence of a barrier.Conclusions. Our observations showed that fractionated electrograms recorded in myocardium damaged by cardiomyopathy were due to both distinct, long strands and short stretches of fibrous tissue. Delayed conduction was caused by curvation of activation around the distinct lines of block and by the wavy course of activation between the short barriers. The latter reflects extreme nonuniform anisotropy.