Throne R D, Jenkins J M, Winston S A, Finelli C J, DiCarlo L A
Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor.
Pacing Clin Electrophysiol. 1989 Oct;12(10):1622-30. doi: 10.1111/j.1540-8159.1989.tb01841.x.
The prevention of pacemaker-mediated tachycardias requires a safe, reliable method for distinguishing retrograde from anterograde atrial activation by dual chamber pacemakers. In this study, a technique was developed to detect the morphological change that occurs in the waveform of the intra-atrial electrogram during retrograde atrial activation. The method employed for waveform analysis is based upon statistical correlation. In 19 patients undergoing electrophysiological studies, atrial electrograms were recorded from bipolar endocardial electrodes during sinus rhythm and 1:1 retrograde atrial depolarization while undergoing right ventricular pacing. Data were digitally sampled at 750, 1,000, and 1,500 Hz. Templates of anterograde atrial depolarization were constructed by signal averaging waveforms from an initial sinus rhythm passage. These were used for analysis of anterograde depolarizations from a subsequent passage of sinus rhythm and a passage of known retrograde atrial depolarization. In all 19 cases, a patient-specific threshold could be derived to separate anterograde from retrograde atrial depolarizations using 1,000 Hz and 1,500 Hz sampling rates. However, at a sampling rate of 750 Hz, separation of anterograde from retrograde atrial activation was possible in only 16/19 patients (84%). We conclude that correlation waveform analysis of a suitably sampled atrial electrogram is a reliable method of discriminating retrograde atrial depolarization from anterograde atrial depolarization in intracardiac electrograms.
预防起搏器介导的心动过速需要一种安全、可靠的方法，以便双腔起搏器能够区分逆行与顺行心房激动。在本研究中，开发了一种技术来检测逆行心房激动期间心房内心电图波形中发生的形态变化。用于波形分析的方法基于统计相关性。在19例接受电生理研究的患者中，在窦性心律和右心室起搏时1:1逆行心房去极化期间，从双极心内膜电极记录心房电图。数据以750、1000和1500Hz进行数字采样。通过对初始窦性心律通过时的信号平均波形构建顺行心房去极化模板。这些模板用于分析随后窦性心律通过和已知逆行心房去极化通过时的顺行去极化。在所有19例病例中，使用1000Hz和1500Hz采样率可以得出患者特异性阈值，以区分顺行与逆行心房去极化。然而，在750Hz采样率下，仅16/19例患者（84%）能够区分顺行与逆行心房激动。我们得出结论，对适当采样的心房电图进行相关波形分析是区分心内心电图中逆行心房去极化与顺行心房去极化的可靠方法。
