Kadish A H, Morady F, Rosenheck S, Summitt J, Schmaltz S
Division of Cardiology, University of Michigan Medical Center, Ann Arbor.
Pacing Clin Electrophysiol. 1989 Sep;12(9):1445-50. doi: 10.1111/j.1540-8159.1989.tb06148.x.
Although "unipolar electrograms" recorded from the His-bundle position have been used to help position catheters for His-bundle ablation, the techniques used to record such electrograms have not been standardized. The effects of five anode locations (right chest wall, anterior chest wall, left chest wall, posterior chest wall, and inferior vena cava) on unipolar atrial, His bundle and ventricular electrograms recorded from the His-bundle position were examined in ten patients undergoing clinical electrophysiology studies. Electrograms were recorded at filter settings of 50-500 as well as 0.05-1000 Hz. The location of the anode had no consistent effect on the amplitude, duration or morphology of any of the electrograms at either filter setting, but signals recorded with the inferior vena cava anode had the highest signal-to-noise ratio. A filter setting of 50-500 Hz decreased the amplitude of atrial (0.72 to 0.33 mV-P less than 0.01), His bundle (0.38 vs 0.32 mV-P less than 0.01) and ventricular electrograms (3.71 vs 2.01 mV-P less than 0.001) compared to a filter setting of 0.05-1,000 Hz. The filter setting did not affect electrogram duration. We concluded that the use of an electrode catheter in the inferior vena cava as the anode when recording "unipolar electrograms" from the His-bundle position yields a better signal-to-noise ratio than a skin patch on the chest and appears to be the optimal method for recording unipolar electrograms.
尽管从希氏束部位记录的“单极电图”已被用于帮助确定用于希氏束消融的导管位置，但用于记录此类电图的技术尚未标准化。在10例接受临床电生理研究的患者中，研究了五个阳极位置（右胸壁、前胸壁、左胸壁、后胸壁和下腔静脉）对从希氏束部位记录的单极心房、希氏束和心室电图的影响。分别在50 - 500以及0.05 - 1000Hz的滤波设置下记录电图。在任一滤波设置下，阳极位置对任何电图的幅度、持续时间或形态均无一致影响，但使用下腔静脉阳极记录的信号具有最高的信噪比。与0.05 - 1000Hz的滤波设置相比，50 - 500Hz的滤波设置降低了心房电图（0.72对0.33mV - P＜0.01）、希氏束电图（0.38对0.32mV - P＜0.01）和心室电图（3.71对2.01mV - P＜0.001）的幅度。滤波设置不影响电图持续时间。我们得出结论，当从希氏束部位记录“单极电图”时，使用下腔静脉内的电极导管作为阳极比胸部皮肤贴片产生更好的信噪比，似乎是记录单极电图的最佳方法。
