Jenkins J M, DiCarlo L A, Chiang C M
Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor 48109-2122.
Pacing Clin Electrophysiol. 1991 Nov;14(11 Pt 2):1809-14. doi: 10.1111/j.1540-8159.1991.tb02771.x.
Signal analysis of digitized waveforms has been postulated as a method for improving sensitivity and specificity of ventricular tachycardia (VT) detection in implantable antitachycardia devices. Such improvement may alleviate the problem of unwarranted delivery of therapy by adding precision to the identification of the pathological VT. Morphological analysis could also allow distinct therapies to be initialized for multiple VTs in the same patient. Correlation waveform analysis (CWA) has been demonstrated to be effective in separating benign rhythms from VT in wideband recordings (1-500 Hz) but the effect of filtering has not been previously examined. Bipolar (1 cm) intraventricular recordings (1-500 Hz) of sinus rhythm (SR) and 25 distinct VTs in 18 patients were analyzed by CWA using a signal-averaged SR template. Passages contained 65.9 +/- 19.8 VT depolarizations (range 45-108). Digital filtering was performed on all data passages with varying passbands. Results for passages with a bandwidth of 1-250 Hz were equivalent to wideband results, i.e., greater than or equal to 92% paired sets of SR and VT were separable at a 95% confidence level. A bandwidth of 1-100 Hz decreased discrimination to 84%. At a bandwidth of 1-80 Hz, 80% of cases were successfully separated, but at 10-80 Hz these results improved to 88%. Bandwidths of 20-80 and 30-80 Hz reduced reliability of CWA performance to 72% and 60%, respectively. Filtering at typical pacemaker/defibrillator passbands produced morphological analysis results equivalent to those yielded at wideband settings. Differences in the range between SR versus VT decreased in filtered recordings but overall detection of VT was not degraded.
数字化波形的信号分析已被假定为一种提高植入式抗心动过速设备中室性心动过速（VT）检测灵敏度和特异性的方法。这种改进可能通过提高病理性VT识别的精确性来缓解不必要的治疗输送问题。形态学分析还可以为同一患者的多种VT启动不同的治疗。相关波形分析（CWA）已被证明在宽带记录（1 - 500 Hz）中能有效区分良性心律和VT，但之前尚未研究过滤波的影响。使用信号平均窦性心律（SR）模板，通过CWA分析了18例患者的双极（1 cm）心室内记录（1 - 500 Hz）的窦性心律（SR）和25种不同的VT。通道包含65.9±19.8次VT去极化（范围45 - 108）。对所有具有不同通带的数据通道进行数字滤波。带宽为1 - 250 Hz的通道结果与宽带结果相当，即在95%置信水平下，大于或等于92%的SR和VT配对集可分离。1 - 100 Hz的带宽使辨别率降至84%。在1 - 80 Hz的带宽下，80%的病例成功分离，但在10 - 80 Hz时这些结果提高到88%。20 - 80 Hz和30 - 80 Hz的带宽分别将CWA性能的可靠性降至72%和60%。在典型的起搏器/除颤器通带进行滤波产生的形态学分析结果与宽带设置下的结果相当。滤波记录中SR与VT之间范围的差异减小，但VT的总体检测未降低。
