Brunckhorst C B, Stevenson W G, Jackman W M, Kuck K-H, Soejima K, Nakagawa H, Cappato R, Ben-Haim S A
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Eur Heart J. 2002 Jul;23(14):1131-8. doi: 10.1053/euhj.2001.3110.
Conduction through separated myocyte bundles causes multipotential electrograms and reentrant ventricular tachycardia. We hypothesized that without initiating tachycardia, the reentry region could be detected by analysing the change in multipotential electrograms during two different activation sequences.
During catheter mapping and ablation in 16 patients with ventricular tachycardia late after infarction ventricular electrograms were recorded from 1072 sites during atrial and right ventricular paced ventricular activation. Multipotential electrograms were present during both activation sequences at 285 (27%) sites, during atrial pacing only at 159 (15%) sites and during right ventricular pacing only at 152 (14%) sites. Sites with multipotential electrograms during both activation sequences were more often related to a ventricular tachycardia circuit isthmus (43%) as compared to sites where such electrograms were present during one activation sequence (20%). Multipotential electrograms with >2 low amplitude deflections and a >100 ms difference in duration between the two activation sequences were infrequent but highly predictive of the reentry circuit.
Regions with fixed multipotentials consistent with conduction block might be useful guides for ablation approaches that target large regions of the infarct, but are not sufficiently specific to be the sole guide for focal ablation approaches.
通过分离的心肌细胞束传导会导致多电位电图和折返性室性心动过速。我们假设，在不引发心动过速的情况下，可通过分析两种不同激动顺序期间多电位电图的变化来检测折返区域。
在16例心肌梗死后晚期室性心动过速患者进行导管标测和消融期间，在心房和右心室起搏心室激动时从1072个部位记录心室电图。在两种激动顺序期间，285个（27%）部位均存在多电位电图，仅在心房起搏时159个（15%）部位存在，仅在右心室起搏时152个（14%）部位存在。与仅在一种激动顺序期间存在此类电图的部位（20%）相比，在两种激动顺序期间均存在多电位电图的部位更常与室性心动过速环路峡部相关（43%）。具有>2个低振幅偏转且两种激动顺序之间持续时间差异>100毫秒的多电位电图并不常见，但对折返环路具有高度预测性。
具有与传导阻滞一致的固定多电位的区域可能是针对大面积梗死区域的消融方法的有用指导，但特异性不足以成为局灶性消融方法的唯一指导。
