SippensGroenewegen A, Lesh M D, Roithinger F X, Ellis W S, Steiner P R, Saxon L A, Lee R J, Scheinman M M
Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco 94143-1354, USA.
J Am Coll Cardiol. 2000 Apr;35(5):1276-87. doi: 10.1016/s0735-1097(00)00549-0.
This 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.
Electrocardiographic classification of CCW and CW typical atrial Fl is frequently hampered by inaccurate and inconclusive scalar waveform analysis of the 12-lead ECG.
Electrocardiogram 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.
The 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.
The 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.
本研究旨在制定空间62导联心电图（ECG）标准，用于对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（Fl）进行分类。
12导联心电图的标量波形分析不准确且不确定，常常阻碍CCW和CW典型心房Fl的心电图分类。
在CCW典型心房Fl（12例患者）、CW典型Fl（3例患者）、两种典型Fl（4例患者）以及CCW典型和非典型心房Fl（1例患者）期间，获取了来自62个躯干部位的心电图信号和多部位心内膜记录。所有Fl波发作被分为两个或三个连续的时间段，这些时间段显示出稳定的电位分布，并据此计算积分图。
CCW Fl波图的初始、中间和终末模式分别与以下情况相符：1）右心房隔的尾颅激活以及冠状窦从近端到远端的激活；2）右心房游离壁的颅尾激活；3）下腔静脉峡部外侧部分的激活。CW Fl波图的初始、中间和终末模式分别与以下情况对应：1）右心房隔的颅尾激活；2）下腔静脉峡部的激活以及冠状窦从近端到远端的激活；3）右心房游离壁的尾颅激活。在建立了高度的患者间积分图模式定量对应关系后，无论是否存在器质性心脏病，计算出了三个连续Fl波期的典型CCW和CW平均积分图的参考集。
人类CCW和CW典型心房Fl的62导联心电图的特征是具有刻板的空间电压分布，该分布可直接与潜在的激活序列相关，并且对Fl波旋转方向具有高度特异性。CCW和CW Fl波平均积分图为典型心房Fl的临床检测和分类提供了独特的参考集。
