Chen P S, Moser K M, Dembitsky W P, Auger W R, Daily P O, Calisi C M, Jamieson S W, Feld G K
Division of Cardiology, UCSD Medical Center 92103.
Circulation. 1991 Jan;83(1):104-18. doi: 10.1161/01.cir.83.1.104.
To map global epicardial repolarization patterns and test the "SI" model of T wave generation, the patterns of epicardial activation and repolarization in patients with chronic pulmonary thromboembolism and right ventricular hypertrophy were studied by computerized mapping techniques and monophasic action potential (MAP) recording. The ventricular activation patterns were characterized by delayed right ventricular activation and the absence of normal early epicardial ventricular breakthrough in some cases. The repolarization patterns were characterized by nonuniform distribution of T wave morphologies. The T waves were predominantly positive over the left ventricular epicardium and negative or biphasic over the right ventricular epicardium. The activation-recovery (A-R) intervals were measured from the local activation to the maximal dV/dt of the upstroke of the T waves (Wyatt method). The difference between the A-R intervals and the MAP from onset of activation to 90% repolarization (MAP90) varies according to T wave morphology and could be as high as 96 msec with positive T waves, despite significant correlations (r = 0.56-0.90) between MAP90 and A-R intervals for each morphology. Better overall correlations were found if the minimal dV/dt on the downslope of the positive T waves was chosen to estimate the time of local repolarization (alternative method). Using this method, the mean A-R intervals were the same over the right and left ventricles. Cardiopulmonary bypass significantly prolonged the action potential duration equally at all parts of the epicardium. We conclude that in patients with right ventricular hypertrophy, the time of local repolarization can be estimated by our alternative method; the right ventricle completes activation and repolarization later than the left ventricle, and the distribution of T wave morphologies is nonuniform, with predominantly positive T waves observed over the left ventricle and negative or biphasic T waves observed over the right ventricle. These findings are compatible with the SI model of the generation of T waves.
为了绘制全球心外膜复极模式并测试T波产生的“SI”模型，采用计算机映射技术和单相动作电位（MAP）记录法，研究了慢性肺血栓栓塞症和右心室肥厚患者的心外膜激活和复极模式。心室激活模式的特点是右心室激活延迟，部分病例缺乏正常的心外膜心室早期突破。复极模式的特点是T波形态分布不均匀。T波在左心室心外膜上主要为正向，在右心室心外膜上为负向或双向。激活-恢复（A-R）间期从局部激活测量至T波上升支最大dV/dt（怀亚特法）。A-R间期与从激活开始到90%复极的MAP（MAP90）之间的差异因T波形态而异，正向T波时差异可达96毫秒，尽管每种形态的MAP90与A-R间期之间存在显著相关性（r = 0.56 - 0.90）。如果选择正向T波下降支的最小dV/dt来估计局部复极时间（替代方法），则总体相关性更好。使用该方法，左右心室的平均A-R间期相同。体外循环显著延长了心外膜各部位的动作电位持续时间。我们得出结论，在右心室肥厚患者中，可通过我们的替代方法估计局部复极时间；右心室完成激活和复极的时间晚于左心室，T波形态分布不均匀，左心室上主要观察到正向T波，右心室上观察到负向或双向T波。这些发现与T波产生的SI模型相符。
