Greenhut S E, Dicarlo L A, Jenkins J M, Throne R D, Winston S A
Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor.
Pacing Clin Electrophysiol. 1991 Mar;14(3):427-33. doi: 10.1111/j.1540-8159.1991.tb04091.x.
Implantable antitachycardia devices suffer a high false-positive rate of delivery of therapy because current detection schemes based upon ventricular rate and rate variations are excessively sensitive at the cost of specificity. Several methods have been proposed for providing complementary information derived from morphologic analysis of intraventricular electrograms in order to increase specificity. The majority of these techniques have utilized bipolar electrogram analysis to detect changes in ventricular activation indicative of ventricular tachycardia. Whether bipolar or unipolar intracardiac electrogram analysis might be preferred for discriminating ventricular tachycardia from sinus rhythm has not been determined. In this study, a previously demonstrated method for identification of ventricular tachycardia using intracardiac electrograms, correlation waveform analysis, was used to analyze both unipolar and bipolar signals during sinus rhythm and ventricular tachycardia recorded during electrophysiology studies of 15 patients with inducible sustained monomorphic ventricular tachycardia. Correlation waveform analysis consistently discriminated between all depolarizations during ventricular tachycardia in 14/15 patients (93%) using either electrogram configuration; 13 of the 14 patients were common to both groups. Of these patients, 8/15 (53%) had greater separation between sinus rhythm and ventricular waveforms with bipolar electrogram analysis while 7/15 (47%) had greater separation with unipolar electrogram analysis. We conclude that morphologic analysis of unipolar and bipolar electrograms may be equally effective in distinguishing ventricular tachycardia from sinus rhythm. For individual patients, either a unipolar or bipolar ventricular configuration may be preferable, and should be chosen on a patient-specific basis during electrophysiology study prior to antitachycardia device implantation.
植入式抗心动过速设备存在较高的治疗误触发率，因为基于心室率和心率变化的当前检测方案过于敏感，以牺牲特异性为代价。已经提出了几种方法来提供从心室内电图形态分析得出的补充信息，以提高特异性。这些技术中的大多数利用双极电图分析来检测指示室性心动过速的心室激活变化。尚未确定双极或单极心内电图分析对于区分室性心动过速和窦性心律是否更可取。在本研究中，一种先前已证明的使用心内电图识别室性心动过速的方法，即相关波形分析，被用于分析15例可诱发持续性单形性室性心动过速患者在电生理研究期间记录的窦性心律和室性心动过速时的单极和双极信号。相关波形分析使用任一电图配置在14/15例患者（93%）的室性心动过速期间的所有去极化之间始终能够区分；14例患者中有13例在两组中是相同的。在这些患者中，8/15（53%）在双极电图分析中窦性心律和室性波形之间的分离更大，而7/15（47%）在单极电图分析中分离更大。我们得出结论，单极和双极电图的形态分析在区分室性心动过速和窦性心律方面可能同样有效。对于个体患者，单极或双极心室配置可能更可取，并且在植入抗心动过速设备之前的电生理研究期间应根据患者的具体情况进行选择。
