van Dessel P F, van Hemel N M, de Bakker J M, Linnenbank T A, Potse M, Jessurun E R, SippensGroenewegen A, Wever E F
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Cardiovasc Electrophysiol. 2001 Nov;12(11):1232-41. doi: 10.1046/j.1540-8167.2001.01232.x.
Body surface mapping (BSM) can be used to identify the site of earliest endocardial activation of ventricular tachycardias (VTs). The multielectrode QRS morphology during VT is determined by both the site of earliest activation and the subsequent spread of electrical activation through the ventricles. This study investigated the relationship between the site of earliest endocardial activation, endocardial spread of activation, and the morphology of the multielectrode surface map in patients with remote myocardial infarction.
In 14 patients with VT late (8.2+/-5.2 years) after myocardial infarction, BSM and simultaneous left ventricular 64-site basket endocardial mapping was performed during a total of 17 monomorphic VTs. In addition, multisite pacing by sequential use of the 64 basket electrodes was performed in 9 patients. BSM and basket mapping revealed the same endocardial breakthrough sites in 8 (47%) of 17 VTs and 189 (59%) of 322 pacing sites; adjacent sites were found in 2 (12%) of 17 VTs and 36 (11%) of 322 pacing sites. Large zones of conduction block explained the mismatch in localization in 2 (12%) of 17 VTs and 52 (16%) of 322 pacing sites. Regional differences in endocardial electrogram amplitudes were found as a cause for dissimilarity in 3 (18%) of 17 VTs and 73 (23%) of 322 pacing sites. Multiple endocardial breakthrough sites were found in 1 (6%) of 17 VTs and 8 (2%) of 322 pacing sites Finally, an epicardial exit site was suggested in 3 (18%) of 17 VTs as an explanation for mismatch, as no early endocardial activity could be recorded.
Zones of conduction block, regional differences in signal amplitude, and multiple endocardial breakthrough sites are frequent causes for mismatch between BSM and basket catheter activation mapping.
体表标测（BSM）可用于识别室性心动过速（VT）最早的心内膜激动部位。VT期间的多电极QRS形态由最早激动部位以及随后电激动在心室中的传播共同决定。本研究调查了陈旧性心肌梗死患者最早心内膜激动部位、激动在心内膜的传播与多电极体表图形态之间的关系。
对14例心肌梗死后晚期（8.2±5.2年）发生VT的患者，在总共17次单形性VT发作期间进行了BSM和同步左心室64位点篮状心内膜标测。此外，对9例患者依次使用64个篮状电极进行了多部位起搏。BSM和篮状标测在17次VT中的8次（47%）以及322个起搏位点中的189个（59%）显示相同的心内膜突破位点；在17次VT中的2次（12%）以及322个起搏位点中的36个（11%）发现相邻位点。大的传导阻滞区域解释了17次VT中的2次（12%）以及322个起搏位点中的52个（16%）定位不匹配的原因。在心内膜电图振幅上发现区域差异是17次VT中的3次（18%）以及322个起搏位点中的73个（23%）不一致的原因。在17次VT中的1次（6%）以及322个起搏位点中的8个（2%）发现多个心内膜突破位点。最后，在17次VT中的3次（18%）提示存在心外膜出口位点以解释不匹配，因为未记录到早期心内膜活动。
传导阻滞区域、信号振幅的区域差异以及多个心内膜突破位点是BSM与篮状导管激动标测之间不匹配的常见原因。
