除颤器电图在识别临床室性心动过速和缺血性室性心动过速的起搏标测中的价值。
The value of defibrillator electrograms for recognition of clinical ventricular tachycardias and for pace mapping of post-infarction ventricular tachycardia.
机构信息
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
J Am Coll Cardiol. 2010 Sep 14;56(12):969-79. doi: 10.1016/j.jacc.2010.04.043.
OBJECTIVES
The purpose of this study was to assess the value of implantable cardioverter-defibrillator (ICD) electrograms (EGMs) in identifying clinically documented ventricular tachycardias (VTs).
BACKGROUND
Twelve-lead electrocardiograms (ECG) of spontaneous VT often are not available in patients referred for catheter ablation of post-infarction VT. Many of these patients have ICDs, and the ability of ICD EGMs to identify a specific configuration of VT has not been described.
METHODS
In 21 consecutive patients referred for catheter ablation of post-infarction VT, 124 VTs (mean cycle length: 393 ± 103 ms) were induced, and ICD EGMs were recorded during VT. Clinical VT had been documented with 12-lead ECGs in 15 of 21 patients. The 12-lead ECGs of the clinical VTs were compared with 64 different inducible VTs (mean cycle length: 390 ± 91 ms) to assess how well the ICD EGMs differentiated the clinical VTs from the other induced VTs. The exit site of 62 VTs (mean cycle length: 408 ± 112 ms) was identified by pace mapping (10 to 12 of 12 matching leads). The spatial resolution of pace mapping to identify a VT exit site was determined for both the 12-lead ECGs and the ICD EGMs using a customized MATLAB program (version 7.5, The MathWorks, Inc., Natick, Massachusetts).
RESULTS
Analysis of stored EGMs by comparison of receiver-operating characteristic curve cutoff values accurately distinguished the clinical VTs from 98% of the other inducible VTs. The mean spatial resolution of a 12-lead ECG pace map for the VT exit site was 2.9 ± 4.0 cm(2) (range 0 to 17.5 cm(2)) compared with 8.9 ± 9.0 cm(2) (range 0 to 35 cm(2)) for ICD EGM pace maps. The spatial resolution of pace mapping varied greatly between patients and between VTs. The spatial resolution of ICD EGMs was < 1.0 cm(2) for ≥ 1 of the target VTs in 12 of 21 patients and 19 of 62 VTs. By visual inspection of the ICD EGMs, 96% of the clinical VTs were accurately differentiated from previously undocumented VTs.
CONCLUSIONS
Stored ICD EGMs usually are an accurate surrogate for 12-lead ECGs for differentiating clinical VTs from other VTs. Pace mapping based on ICD EGMs has variable resolution but may be useful for identifying a VT exit site.
目的
本研究旨在评估植入式心脏复律除颤器（ICD）心电图（EGM）在识别临床记录的室性心动过速（VT）中的价值。
背景
接受心肌梗死后 VT 导管消融治疗的患者常无法获得自发性 VT 的 12 导联心电图（ECG）。这些患者中有许多人都装有 ICD，ICD EGM 识别特定 VT 形态的能力尚未得到描述。
方法
在 21 例连续接受心肌梗死后 VT 导管消融治疗的患者中，诱发了 124 次 VT（平均周长：393±103ms），并在 VT 期间记录 ICD EGM。21 例患者中有 15 例的临床 VT 通过 12 导联 ECG 记录。将临床 VT 的 12 导联 ECG 与 64 次不同的可诱导 VT（平均周长：390±91ms）进行比较，以评估 ICD EGM 区分临床 VT 和其他诱导 VT 的能力。通过起搏映射（12 个匹配导联中的 10-12 个）确定 62 次 VT（平均周长：408±112ms）的出口部位。使用定制的 MATLAB 程序（版本 7.5，The MathWorks，Inc.，马萨诸塞州纳提克）确定 12 导联 ECG 和 ICD EGM 识别 VT 出口部位的空间分辨率。
结果
通过比较接收器工作特征曲线截断值分析存储的 EGM，可准确区分临床 VT 和 98%的其他可诱导 VT。用于 VT 出口部位的 12 导联 ECG 起搏图的平均空间分辨率为 2.9±4.0cm2（范围 0 至 17.5cm2），而 ICD EGM 起搏图为 8.9±9.0cm2（范围 0 至 35cm2）。起搏图的空间分辨率在患者之间和 VT 之间差异很大。12 个患者中有 12 个，62 个 VT 中有 19 个的目标 VT 中的至少 1 个的 ICD EGM 空间分辨率<1.0cm2。通过对 ICD EGM 的直观检查，96%的临床 VT 与之前未记录的 VT 准确区分。
结论
存储的 ICD EGM 通常是区分临床 VT 和其他 VT 的 12 导联 ECG 的准确替代方法。基于 ICD EGM 的起搏图具有可变的分辨率，但可能有助于识别 VT 出口部位。
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