Ciaccio Edward J
Department of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
J Cardiovasc Electrophysiol. 2005 Jun;16(6):646-54. doi: 10.1046/j.1540-8167.2005.40690.x.
Successful prediction of reentrant ventricular tachycardia duration and form from sinus-rhythm electrogram signals in canine hearts is relevant to clinical studies, to potentially improve catheter ablation treatment during EP study.
METHODS/RESULTS: Following LAD ligation of canine hearts, activation maps were constructed from 312 border zone sites 4-5 days postinfarction. When reentrant ventricular tachycardia was inducible via programmed stimulation, the core of the circuit was defined on the maps as the enclosed area formed by the adjoining lines of slowest conduction and block bounding the protected region of the reentrant circuit. The number, location, and width of points of entrance or exit of the activation wavefront about the core were determined. Core perimeter location was then marked on the sinus-rhythm activation map, and the difference in activation time at opposite recording sites along the core perimeter was measured. Mean sinus-rhythm activation was highly discontinuous along the core perimeter in 10 transient reentry experiments (30.1 +/- 4.4 ms), moderately discontinuous in 13 sustained experiments (16.7 +/- 1.8 ms), and only slightly discontinuous in 5 noninducible experiments (9.7 +/- 1.7 ms). For transient versus sustained experiments, the entrance/exit points were narrower (mean: 6.5 +/- 1.0 mm vs 9.5 +/- 1.8 mm) with larger sinus-rhythm discontinuity across them (mean: 23.8 +/- 6.0 ms vs 11.8 +/- 2.1 ms). As core size increased, so did the number of entrance/exits present during reentry (P < 0.001). With increasing core size, four-loop (quatrefoil) reentry was frequently observed.
Whether reentrant ventricular tachycardia will be inducible in the canine infarct border zone, and its duration and form, is associated with the characteristics of electrical discontinuities present about the core perimeter.
从犬类心脏的窦性心律心电图信号成功预测折返性室性心动过速的持续时间和形态与临床研究相关，有可能改善电生理研究期间的导管消融治疗。
方法/结果：在犬类心脏进行左前降支结扎后，在梗死后4 - 5天从312个边界区部位构建激动标测图。当通过程序刺激可诱发折返性室性心动过速时，在标测图上，折返环的核心被定义为由最慢传导线和界定折返环保护区的阻滞相邻线所形成的封闭区域。确定围绕核心的激动波前的入口或出口点的数量、位置和宽度。然后在窦性心律激动标测图上标记核心周长位置，并测量沿核心周长相对记录部位的激动时间差异。在10次短暂性折返实验中，平均窦性心律激动沿核心周长高度不连续（30.1±4.4毫秒），在13次持续性实验中中度不连续（16.7±1.8毫秒），在5次不可诱发实验中仅轻微不连续（9.7±1.7毫秒）。对于短暂性与持续性实验，入口/出口点更窄（平均：6.5±1.0毫米对9.5±1.8毫米），穿过它们的窦性心律不连续性更大（平均：23.8±6.0毫秒对11.8±2.1毫秒）。随着核心大小增加，折返期间存在的入口/出口数量也增加（P<0.001）。随着核心大小增加，经常观察到四环（四叶形）折返。
犬类梗死边界区是否可诱发折返性室性心动过速及其持续时间和形态与核心周长处存在的电不连续性特征相关。
