SippensGroenewegen A, Spekhorst H, van Hemel N M, Kingma J H, Hauer R N, Janse M J, Dunning A J
Department of Clinical and Experimental Cardiology, University of Amsterdam, The Netherlands.
Circulation. 1990 Sep;82(3):879-96. doi: 10.1161/01.cir.82.3.879.
The value of simultaneous 62-lead electrocardiographic recordings in localizing the site of origin of ectopic ventricular activation in a structurally normal heart was assessed by examining body surface QRS integral maps in 12 patients during left and right ventricular (LV and RV) pacing at 182 distinct endocardial sites. A data base of 38 characteristic mean integral maps was composed after visually selecting subgroups with nearly identical total QRS integral morphology and numerically evaluating intrasubgroup pattern uniformity and intersubgroup pattern variability. Corresponding endocardial pacing site locations were computed by a biplane cineradiographic method and outlined as segments on a standardized LV and RV polar projection. LV pacing resulted in 25 markedly different mean total QRS integral patterns, showing higher electrocardiographic sensitivity for anteroseptal (18 patterns) compared with posterolateral regions (seven patterns). RV pacing demonstrated 13 mean total QRS integral patterns, exhibiting less intersubgroup variation and comparatively low electrocardiographic sensitivity for the basal anterior and outflow regions. Comparison of LV with RV pacing revealed that QRS configurations produced at LV apical and LV midseptal sites closely resembled QRS configurations generated at RV apical, RV septal, and RV anterior sites, respectively. Total QRS time integral amplitudes showed considerable intrasubgroup variation but permitted global differentiation of spatially similar QRS patterns obtained during pacing at LV and RV sites. This study demonstrates that the QRS pattern of the total body surface electrocardiogram allows discrimination among 38 different LV and RV segments of ectopic endocardial impulse formation in patients with normal cardiac anatomy.
通过在12例患者的182个不同心内膜部位进行左心室和右心室起搏时检查体表QRS积分图，评估了同步62导联心电图记录在定位结构正常心脏中异位心室激动起源部位的价值。在目视选择具有几乎相同总QRS积分形态的亚组并对亚组内模式均匀性和亚组间模式变异性进行数值评估后，构建了一个包含38个特征性平均积分图的数据库。通过双平面电影造影法计算相应的心内膜起搏部位位置，并在标准化的左心室和右心室极坐标投影上勾勒为节段。左心室起搏产生了25种明显不同的平均总QRS积分模式，与后外侧区域（7种模式）相比，对前间隔区域（18种模式）显示出更高的心电图敏感性。右心室起搏显示出13种平均总QRS积分模式，亚组间变化较小，对基底前壁和流出道区域的心电图敏感性相对较低。左心室起搏与右心室起搏的比较显示，左心室心尖部和左心室中隔部产生的QRS形态分别与右心室心尖部、右心室间隔部和右心室前壁产生的QRS形态非常相似。总QRS时间积分幅度显示出相当大的亚组内变化，但允许对在左心室和右心室部位起搏期间获得的空间相似的QRS模式进行整体区分。这项研究表明，体表心电图的QRS模式能够区分心脏解剖结构正常患者的心内膜异位冲动形成的38个不同的左心室和右心室节段。
