de Bakker J M, van Capelle F J, Janse M J, van Hemel N M, Hauer R N, Defauw J J, Vermeulen F E, Bakker de Wekker P F
Department of Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
J Am Coll Cardiol. 1991 Oct;18(4):1005-14. doi: 10.1016/0735-1097(91)90760-7.
Endocardial mapping of electrical activity was carried out in 150 patients to guide antiarrhythmic surgery for drug-resistant ventricular tachycardia in the chronic phase of myocardial infarction. In 20 of these patients, the activation pattern of 27 distinct tachycardias was focal and diastolic potentials were recorded at three or more sites. In 26 tachycardias, the sequence of diastolic potentials progressed from the area of latest activation of one cycle toward the "origin" of the next cycle. In two patients, the heart was stimulated during tachycardia, resulting in entrainment of the tachycardia in both. Late potentials were recorded during entrainment at sites where diastolic potentials occurred during tachycardia. In 11 of the 20 patients, endocardial mapping was performed during sinus rhythm. In four of these, late potentials were observed during sinus rhythm at sites where diastolic potentials were recorded during tachycardia. In two patients without late potentials during sinus rhythm, late potentials were observed during stimulation and induced ectopic beats. The results support the concept that the mechanism of several of these tachycardias is based on reentry in a macrocircuit comprising a tract of surviving tissue traversing the infarct and the remaining healthy tissue. They also indicate that the absence of late potentials during sinus rhythm does not guarantee the absence of arrhythmogenic pathways.
对150例患者进行了心内膜电活动标测，以指导心肌梗死慢性期药物难治性室性心动过速的抗心律失常手术。在这些患者中，20例患者的27种不同心动过速的激动模式为局灶性，且在三个或更多部位记录到舒张期电位。在26种心动过速中，舒张期电位的顺序从一个心动周期最晚激动的区域向随后心动周期的“起源点”进展。在2例患者中，心动过速期间对心脏进行刺激，结果二者均出现心动过速的拖带现象。在拖带期间，于心动过速时出现舒张期电位的部位记录到了延迟电位。在这20例患者中的11例，于窦性心律期间进行了心内膜标测。其中4例，在窦性心律期间于心动过速时记录到舒张期电位的部位观察到了延迟电位。在2例窦性心律期间无延迟电位的患者中，在刺激及诱发的异位搏动期间观察到了延迟电位。这些结果支持以下概念，即这些心动过速中的几种机制是基于包含一条穿过梗死区及剩余健康组织的存活组织束的大折返环。它们还表明，窦性心律期间无延迟电位并不能保证不存在致心律失常途径。
