SippensGroenewegen A, Spekhorst H, van Hemel N M, Kingma J H, Hauer R N, Janse M J, Dunning A J
Department of Clinical and Experimental Cardiology, University of Amsterdam, The Netherlands.
Circ Res. 1992 Dec;71(6):1361-78. doi: 10.1161/01.res.71.6.1361.
To improve electrocardiographic localization of the site of origin of ectopic left ventricular (LV) impulse formation in the heart with prior myocardial infarction, 62-lead body surface QRS integral maps were studied during LV pacing at a total of 221 endocardial sites in 14 patients with previous anterior (AMI), inferior (IMI), lateral (LMI), or anterior and inferior (AMI/IMI) myocardial infarction. The anatomic location of each pacing site was computed using digitized biplane fluoroscopic images and plotted on standardized LV endocardial polar projections. A data base of characteristic AMI and IMI mean QRS integral maps was developed after visually selecting subgroups with nearly identical QRS integral morphology from the ectopic activation sequences produced at 110 sites in eight patients with AMI and at 66 sites in four patients with IMI. Intrasubgroup pattern uniformity and intersubgroup pattern variability were statistically verified. The endocardial pacing site locations belonging to each AMI and IMI subgroup were depicted as segments on the respective LV polar projections. In patients with AMI, a total of 18 typical mean QRS integral patterns were obtained, whereas 22 different mean total QRS integral patterns showing more substantial intersubgroup variation were acquired in patients with IMI. Posterolateral regions exhibited a relatively low electrocardiographic sensitivity (six AMI and five IMI patterns) as compared with anteroseptal regions (12 AMI and 17 IMI patterns). Total QRS integral patterns obtained at 24 sites in one patient with LMI were largely compatible with the IMI mean total QRS integral patterns, whereas the majority of total QRS integral patterns acquired at 21 sites in one patient with AMI/IMI corresponded with the AMI mean total QRS integral patterns. The results show that total body surface QRS integral maps generated during LV pacing in patients with prior myocardial infarction cluster by pattern and that each QRS integral pattern is related to a circumscribed endocardial segment of ectopic impulse formation. The relation between a given QRS integral pattern and the position and size of the corresponding paced segment is dependent on infarct location. The present infarct-specific data base of characteristic total body surface QRS integral patterns provides a clinical tool to obtain detailed electrocardiographic localization of ventricular arrhythmias in patients with previous myocardial infarction.
为改善对既往有心肌梗死患者心脏中异位左心室冲动形成起源部位的心电图定位，在14例既往有前壁心肌梗死（AMI）、下壁心肌梗死（IMI）、侧壁心肌梗死（LMI）或前壁和下壁心肌梗死（AMI/IMI）的患者的221个心内膜部位进行左心室起搏期间，研究了62导联体表QRS积分图。使用数字化双平面荧光透视图像计算每个起搏部位的解剖位置，并绘制在标准化的左心室心内膜极坐标投影图上。在视觉上从8例AMI患者的110个部位和4例IMI患者的66个部位产生的异位激活序列中选择具有几乎相同QRS积分形态的亚组后，建立了特征性AMI和IMI平均QRS积分图数据库。对亚组内模式均匀性和亚组间模式变异性进行了统计学验证。将属于每个AMI和IMI亚组的心内膜起搏部位位置描绘为各自左心室极坐标投影图上的节段。在AMI患者中，共获得18种典型的平均QRS积分模式，而在IMI患者中获得22种不同的平均总QRS积分模式，显示出更显著的亚组间差异。与前间隔区域（12种AMI模式和17种IMI模式）相比，后外侧区域表现出相对较低的心电图敏感性（6种AMI模式和5种IMI模式）。1例LMI患者24个部位获得的总QRS积分模式在很大程度上与IMI平均总QRS积分模式相符，而1例AMI/IMI患者21个部位获得的大多数总QRS积分模式与AMI平均总QRS积分模式相符。结果表明，既往有心肌梗死患者在左心室起搏期间生成的全身表面QRS积分图按模式聚类，并且每个QRS积分模式与异位冲动形成的限定心内膜节段相关。给定的QRS积分模式与相应起搏节段的位置和大小之间的关系取决于梗死部位。目前这个特定梗死的特征性全身表面QRS积分模式数据库提供了一种临床工具，用于获得既往有心肌梗死患者室性心律失常的详细心电图定位。
