典型心房扑动患者体表心电图特征与心内膜激动顺序的关系

Relationship between surface electrocardiogram characteristics and endocardial activation sequence in patients with typical atrial flutter.

作者信息

Ndrepepa G, Zrenner B, Deisenhofer I, Karch M, Schneider M, Schreieck J, Schmitt C

机构信息

Deutsches Herzzentrum München.

出版信息

Z Kardiol. 2000 Jun;89(6):527-37. doi: 10.1007/s003920070225.

DOI:10.1007/s003920070225

PMID:10929438

Abstract

OBJECTIVES

The relationships that exist between endocardial and surface electrocardiogram (ECG) activity in patients with AFl have not been satisfactorily delineated. The aim of the study was to determine the relationships that exist between the atrial endocardial activity and the surface ECG in patients with atrial flutter (AFl).

METHODS

In 40 patients with AFl, a 64-electrode basket catheter (BC) was deployed in the right atrium (RA). A decapolar catheter was inserted into the coronary sinus (CS) to record from the left atrium. The temporal relationship between endocardial and surface ECG activity was determined by means of electronic calipers.

RESULTS

In counterclockwise AFl, the activation of the lateral wall of RA coincided with the positive deflections in lead I, V1 and V6 and the upstroke component in inferior leads. Plateau duration in lead III (121 +/- 27 ms) correlated strongly with isthmus conduction time (117 +/- 23 ms) (r = 0.91). Septal and left atrial conduction coincided with negative components in lead I, inferior leads and V6 and positive deflections in leads aVL and V1. In clockwise AFl, the F wave was notched in all ECG leads. The first component resulted from the activation of the septum and posterior wall of the RA. The second component was coincident with activity recorded in CS electrograms. The interval between the two deflections (60 +/- 18 ms) correlated strongly with interatrial conduction time (57 +/- 19 ms) (r = 0.84). Interatrial conduction interval was prolonged during AFl as compared to sinus rhythm (60 +/- 18 ms vs 43 +/- 13 ms, p = 0.04). Activation of the lateral wall of RA coincided with the negative components in lead I, inferior leads and V6.

CONCLUSIONS

The electrical activity in surface ECG closely correlates with conduction in specific parts of the atria. Polarity of the F wave in an ECG lead is determined by a resultant of opposing activities from the lateral wall of the RA and the left atrium.

摘要

目的

心房扑动（AFl）患者心内膜与体表心电图（ECG）活动之间的关系尚未得到令人满意的阐明。本研究的目的是确定心房扑动（AFl）患者心房心内膜活动与体表心电图之间的关系。

方法

对40例AFl患者，在右心房（RA）置入64电极篮状导管（BC）。将十极导管插入冠状窦（CS）以记录左心房的电活动。通过电子卡尺确定心内膜与体表ECG活动之间的时间关系。

结果

在逆时针方向的AFl中，RA侧壁的激动与I、V1和V6导联的正向偏转以及下壁导联的上升支同时出现。III导联的平台期持续时间（121±27毫秒）与峡部传导时间（117±23毫秒）密切相关（r = 0.91）。间隔和左心房传导与I导联、下壁导联和V6导联的负向成分以及aVL和V1导联的正向偏转同时出现。在顺时针方向的AFl中，所有ECG导联的F波均有切迹。第一个成分源于RA间隔和后壁的激动。第二个成分与CS电图记录的活动同时出现。两个偏转之间的间期（60±18毫秒）与房间传导时间（57±19毫秒）密切相关（r = 0.84）。与窦性心律相比，AFl期间房间传导间期延长（60±18毫秒对43±13毫秒，p = 0.04）。RA侧壁的激动与I导联、下壁导联和V6导联的负向成分同时出现。