Gerstenfeld E P, Sahakian A V, Baerman J M, Ropella K M, Swiryn S
Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.
J Am Coll Cardiol. 1991 Oct;18(4):1034-42. doi: 10.1016/0735-1097(91)90763-y.
The ability of a catheter with an orthogonal electrode configuration to sense differences in the direction of local atrial endocardial activation was tested in 18 consecutive patients with intact retrograde conduction. In all 18, discrimination of anterograde from retrograde conduction at a single atrial site was examined; in 5 of the 18, multiple sites were examined to determine if the discriminatory ability of the catheter was site dependent. The catheter was specially designed with bipoles in the x, y and z directions. A vector was computed for each electrogram during anterograde and retrograde conduction. Electrogram amplitude along the standard bipole was also compared for anterograde and retrograde conduction. Mean electrogram amplitude for the standard bipole was significantly different for anterograde than for retrograde conduction in 17 of 18 patients (mean +/- SD 4 +/- 1.9 vs. 2.7 +/- 1.3 mV; p less than 0.005), with complete separation of amplitude distributions in 4 patients. The electrogram vector during anterograde conduction was significantly different from that during retrograde conduction in all 18 patients (p less than 0.0001), with complete separation of vector distributions in 14. In some patients with multiple site recordings, the choice of site greatly affected separation based on electrogram amplitude or vector, or both. The orthogonal catheter can be used to sense directional differences in local endocardial activation. The catheter shows promise for discriminating anterograde from retrograde conduction and examining the direction of endocardial activation in the heart during an electrophysiologic examination.
在18例逆向传导完整的连续患者中，测试了具有正交电极配置的导管感知局部心房内膜激动方向差异的能力。在所有18例患者中，均检查了单个心房部位顺向传导与逆向传导的辨别情况；在18例中的5例中，检查了多个部位以确定导管的辨别能力是否与部位有关。该导管经过特殊设计，在x、y和z方向上均有双极。在顺向传导和逆向传导期间，为每个心电图计算一个向量。还比较了顺向传导和逆向传导时沿标准双极的心电图振幅。18例患者中有17例，标准双极的平均心电图振幅在顺向传导和逆向传导时存在显著差异（平均±标准差4±1.9mV对2.7±1.3mV；p<0.005），4例患者的振幅分布完全分离。在所有18例患者中，顺向传导期间的心电图向量与逆向传导期间的心电图向量存在显著差异（p<0.0001），14例患者的向量分布完全分离。在一些进行多部位记录的患者中，部位的选择极大地影响了基于心电图振幅或向量或两者的分离情况。正交导管可用于感知局部心内膜激动的方向差异。该导管在电生理检查期间，在辨别顺向传导与逆向传导以及检查心脏内心内膜激动方向方面显示出前景。
