Kuchar D L, Ruskin J N, Garan H
Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114.
J Am Coll Cardiol. 1989 Mar 15;13(4):893-903. doi: 10.1016/0735-1097(89)90232-5.
The utility of the 12 lead electrocardiogram (ECG) in identifying the site of origin of sustained ventricular tachycardia in patients with previous myocardial infarction was studied. A new mapping grid, based on biplanar fluoroscopic imaging of the heart, was utilized for the definition of left ventricular endocardial sites. On the basis of QRS configurations resulting from left ventricular endocardial pacing at disparate sites in 22 patients (Group I), ECG features that were specific for particular sites were identified and used to construct an algorithm. Apical and basal sites were differentiated by the QRS configuration in leads V4 and aVR, anterior and inferior sites by that in leads II, III and V6 and septal and lateral sites were differentiated using leads I, aVL and V1. The algorithm was used to predict the site of earliest endocardial activation during 44 episodes of sustained ventricular tachycardia in a second group of 42 patients (Group II) in a blinded fashion. Anterior sites were correctly predicted in 83% of cases, inferior sites in 84%, septal sites in 90% and lateral sites in 82% of cases. Apical and basal sites were each correctly predicted in 70% of cases, whereas intermediate sites were less well predicted (29 to 55%) on the basis of QRS configuration. Precise localization of the site of origin of ventricular tachycardia (in all three planes) was achieved in 17 cases (39%), and in 16 cases (36%) the site of origin was immediately adjacent to the predicted site. Prediction of the site of origin of ventricular tachycardia from the 12 lead ECG may serve as a useful, time-saving adjunct to, but not a substitute for, activation sequence mapping during ventricular tachycardia.
研究了12导联心电图（ECG）在识别既往心肌梗死患者持续性室性心动过速起源部位方面的效用。基于心脏双平面荧光透视成像的一种新的标测网格被用于定义左心室心内膜部位。根据22例患者（第一组）在不同部位进行左心室心内膜起搏所产生的QRS波形，确定了特定部位特有的ECG特征，并用于构建一种算法。通过V4导联和aVR导联的QRS波形区分心尖部和基底部，通过II、III和V6导联区分前部和下部，通过I、aVL和V1导联区分间隔部和侧壁。该算法以盲法用于预测第二组42例患者（第二组）44次持续性室性心动过速发作期间最早的心内膜激动部位。前部部位在83%的病例中被正确预测，下部部位在84%，间隔部在90%，侧壁在82%。心尖部和基底部在70%的病例中被正确预测，而根据QRS波形，中间部位的预测效果较差（29%至55%）。17例（39%）实现了室性心动过速起源部位（在所有三个平面）的精确定位，16例（36%）起源部位紧邻预测部位。从12导联ECG预测室性心动过速的起源部位可作为一种有用、省时的辅助手段，但不能替代室性心动过速发作时的激动顺序标测。
