Throne R D, Jenkins J M, DiCarlo L A
Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor.
Pacing Clin Electrophysiol. 1990 Oct;13(10):1286-97. doi: 10.1111/j.1540-8159.1990.tb02028.x.
Recent studies have reported a significant false positive rate in delivery of therapy by implantable antitachycardia devices utilizing detection algorithms based on sustained high rate. More selective decision schemes for the recognition of life-threatening arrhythmias have been recently proposed that use analysis of the intrinsic electrogram rather than rate alone. Morphological discrimination of abnormal electrograms using correlation waveform analysis (CWA) has been proposed as an effective method of intracardiac electrogram analysis, but its computational demands limit its use in implantable devices. A new method for intracardiac electrogram analysis, the bin area method (BAM), was created to detect abnormal cardiac conduction with computational requirements of one-half to one-tenth those of CWA. Like CWA, BAM is a template matching method that is sensitive to conduction changes revealed in the electrogram morphology and is independent of amplitude and baseline fluctuations. Performance of BAM and CWA were compared using bipolar right ventricular and right atrial electrode recordings from 47 patients undergoing clinical cardiac electrophysiology studies. Nineteen patients had 31 distinct monomorphic ventricular tachycardias (VTs) induced (group I), thirteen patients had paroxysmal bundle branch block of supraventricular origin (BBB) induced (group II), and 19 patients had retrograde atrial activation during right ventricular overdrive pacing (group III). (One patient was common to all three groups, and two patients were common to groups II and III.) Using the ventricular electrogram, both BAM and CWA distinguished VT from sinus rhythm in 28/31 (90%) cases, and BBB from Normal Sinus Rhythm (NSR) in 13/13 (100%) patients. Using the atrial electrogram, both BAM and CWA distinguished anterograde from retrograde atrial activation in 19/19 (100%) patients. BAM achieves similar performance to CWA with significantly reduced computational demands, and may make real-time analysis of intracardiac electrograms feasible for implantable pacemakers and antitachycardia devices.
近期研究报告称，利用基于持续高心率的检测算法的植入式抗心动过速设备在提供治疗时存在显著的假阳性率。最近有人提出了更具选择性的识别危及生命心律失常的决策方案，该方案使用对固有心电图的分析而非仅依赖心率。利用相关波形分析（CWA）对异常心电图进行形态学鉴别已被提议作为心内电图分析的一种有效方法，但其计算要求限制了它在植入式设备中的应用。一种用于心内电图分析的新方法——箱面积法（BAM）被开发出来，用于检测异常心脏传导，其计算要求仅为CWA的二分之一到十分之一。与CWA一样，BAM是一种模板匹配方法，对心电图形态中显示的传导变化敏感，且与幅度和基线波动无关。使用47例接受临床心脏电生理研究患者的双极右心室和右心房电极记录，对BAM和CWA的性能进行了比较。19例患者诱发出31种不同的单形性室性心动过速（VTs）（第一组），13例患者诱发出室上性起源的阵发性束支传导阻滞（BBB）（第二组），19例患者在右心室超速起搏期间出现逆行心房激动（第三组）。（有1例患者在所有三组中均出现，2例患者在第二组和第三组中均出现。）利用心室电图，BAM和CWA在28/31（90%）的病例中区分了VT与窦性心律，在13/13（100%）的患者中区分了BBB与正常窦性心律（NSR）。利用心房电图，BAM和CWA在19/19（100%）的患者中区分了顺行性与逆行性心房激动。BAM在计算要求显著降低的情况下实现了与CWA相似的性能，并且可能使植入式起搏器和抗心动过速设备对心内电图进行实时分析成为可能。
