Sayadi Omid, Puppala Dheeraj, Ishaque Nosheen, Doddamani Rajiv, Merchant Faisal M, Barrett Conor, Singh Jagmeet P, Heist E Kevin, Mela Theofanie, Martínez Juan Pablo, Laguna Pablo, Armoundas Antonis A
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (O.S., D.P., N.I., R.D., A.A.A.).
Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M.).
J Am Heart Assoc. 2014 Sep 3;3(5):e001055. doi: 10.1161/JAHA.114.001055.
This study investigates the hypothesis that morphologic analysis of intracardiac electrograms provides a sensitive approach to detect acute myocardial infarction or myocardial infarction-induced arrhythmia susceptibility. Large proportions of irreversible myocardial injury and fatal ventricular tachyarrhythmias occur in the first hour after coronary occlusion; therefore, early detection of acute myocardial infarction may improve clinical outcomes.
We developed a method that uses the wavelet transform to delineate electrocardiographic signals, and we have devised an index to quantify the ischemia-induced changes in these signals. We recorded body-surface and intracardiac electrograms at baseline and following myocardial infarction in 24 swine. Statistically significant ischemia-induced changes after the initiation of occlusion compared with baseline were detectable within 30 seconds in intracardiac left ventricle (P<0.0016) and right ventricle-coronary sinus (P<0.0011) leads, 60 seconds in coronary sinus leads (P<0.0002), 90 seconds in right ventricle leads (P<0.0020), and 360 seconds in body-surface electrocardiographic signals (P<0.0022). Intracardiac leads exhibited a higher probability of detecting ischemia-induced changes than body-surface leads (P<0.0381), and the right ventricle-coronary sinus configuration provided the highest sensitivity (96%). The 24-hour ECG recordings showed that the ischemic index is statistically significantly increased compared with baseline in lead I, aVR, and all precordial leads (P<0.0388). Finally, we showed that the ischemic index in intracardiac electrograms is significantly increased preceding ventricular tachyarrhythmic events (P<0.0360).
We present a novel method that is capable of detecting ischemia-induced changes in intracardiac electrograms as early as 30 seconds following myocardial infarction or as early as 12 minutes preceding tachyarrhythmic events.
本研究探讨如下假设，即心内电图的形态学分析可为检测急性心肌梗死或心肌梗死诱发的心律失常易感性提供一种敏感的方法。在冠状动脉闭塞后的第一小时内，会发生很大比例的不可逆心肌损伤和致命性室性快速心律失常；因此，急性心肌梗死的早期检测可能会改善临床结局。
我们开发了一种使用小波变换来描绘心电图信号的方法，并设计了一个指标来量化这些信号中缺血诱导的变化。我们在24头猪身上记录了基线时以及心肌梗死后的体表和心内电图。与基线相比，闭塞开始后，在心内左心室导联（P<0.0016）、右心室-冠状窦导联（P<0.0011）中，30秒内可检测到具有统计学意义的缺血诱导变化；在冠状窦导联中60秒内（P<0.0002），在右心室导联中90秒内（P<0.0020），在体表心电图信号中360秒内（P<0.0022）可检测到。心内导联检测缺血诱导变化的概率高于体表导联（P<0.0381），且右心室-冠状窦配置的敏感性最高（96%）。24小时心电图记录显示，与基线相比，I导联、aVR导联以及所有胸前导联的缺血指数有统计学意义的升高（P<0.0388）。最后，我们表明在心内电图中，缺血指数在室性快速心律失常事件之前显著升高（P<0.0360）。
我们提出了一种新方法，该方法能够在心肌梗死后30秒或快速心律失常事件前12分钟就检测到心内电图中缺血诱导的变化。
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