Eberhardt Frank, Bonnemeier Hendrik, Lipphardt Martin, Hofmann Ulrich G, Schunkert Heribert, Wiegand Uwe K H
University Hospital Schleswig Holstein, Campus Luebeck, Medicine II, Luebeck, Germany.
Ann Noninvasive Electrocardiol. 2006 Apr;11(2):118-26. doi: 10.1111/j.1542-474X.2006.00092.x.
Sophisticated monitoring of atrial activity is a prerequisite for modern pacemaker therapy. Ideally, near-fields and ventricular far-fields ought to be distinguished by beat-to-beat template analysis of the atrial signal. A prerequisite is that atrial signals are stable under different conditions.
A Matlab routine was developed to analyze atrial electrograms of 23 patients at least 3 months after implantation of a dual chamber pacemaker under several conditions including at rest, bipolar at rest, in an upright position, during treadmill exercise, and postexercise. A near-field and far-field template was created and amplitudes, widths, and slew rates were measured. In bipolar configuration, near-field amplitude at rest was 3.04 +/- 0.94 mV (unipolar)/3.36 +/- 1.0 mV (bipolar) versus 3.18 +/- 1.0 mV (bipolar) at peak exercise. Far-field amplitude at rest was 1.66 +/- 1.18 (unipolar)/0.47 +/- 0.27 mV (bipolar) and 0.41 +/- 0.21 mV (bipolar) at peak exercise (n.s. for bipolar measurements). No overall significant changes were observed for near- and far-field widths and slew rates during exercise. Shorter tip-ring distances of the atrial bipole, lead position, and the presence of sinus node disease did not have any impact on overall near- and far-field signal characteristics. Intraindividual differences between rest and peak exercise were moderate (range: near-field +0.15 to -0.54 mV; range: far-field +0.05 to -0.18 mV).
Atrial near and far fields can be automatically classified and quantified by automated signal processing. Signals did not change during exercise or change of posture. This is a prerequisite for the implementation of beat-to-beat template analysis into pacemakers.
对心房活动进行精确监测是现代起搏器治疗的前提条件。理想情况下，应通过对心房信号进行逐搏模板分析来区分近场和心室远场。前提是心房信号在不同条件下保持稳定。
开发了一个Matlab程序，用于分析23例双腔起搏器植入至少3个月后的患者在多种条件下的心房电图，这些条件包括静息状态、静息时双极状态、直立位、跑步机运动期间以及运动后。创建了近场和远场模板，并测量了振幅、宽度和 slew 率。在双极配置中，静息时近场振幅为3.04±0.94 mV（单极）/3.36±1.0 mV（双极），运动峰值时为3.18±1.0 mV（双极）。静息时远场振幅为1.66±1.18（单极）/0.47±0.27 mV（双极），运动峰值时为0.41±0.21 mV（双极）（双极测量无显著性差异）。运动期间近场和远场的宽度及 slew 率未观察到总体显著变化。心房双极的尖端-环距离较短、导线位置以及窦房结疾病的存在对总体近场和远场信号特征没有任何影响。静息与运动峰值之间的个体内差异适中（范围：近场+0.15至-0.54 mV；范围：远场+0.05至-0.18 mV）。
心房近场和远场可通过自动信号处理进行自动分类和量化。信号在运动或姿势改变期间未发生变化。这是将逐搏模板分析应用于起搏器的前提条件。
