Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
Health Care Center, Internal Medicine and Cardiology, Kanto Gakuin University, Yokohama, Kanagawa, Japan.
J Cardiovasc Electrophysiol. 2019 Apr;30(4):575-581. doi: 10.1111/jce.13854. Epub 2019 Feb 2.
While characteristic waveforms of 12-lead electrocardiograms have been reported to predict the epicardial origin of ventricular tachycardia (VT), it has not been fully examined whether ventricular intracardiac electrograms (VEGMs) recorded from the implantable cardioverter defibrillator (ICD) via telemetry can determine the origin of VT or not. The aim of this study was to investigate the VEGM characteristics of VT originating from the epicardia.
Intracardiac VEGMs of the induced VTs, with detected sites of origin during the VT study, were recorded in 15 (23 VTs) of the 46 patients. The characteristics of the 23 VTs were evaluated using far-field and near-field VEGMs recorded via telemetry. Five of 23 VTs were found to be focused on the epicardial site (epi group) and 18 VTs were focused on the endocardium (endo group). VTs of the epi group had longer VEGM duration in far-field EGM than those of the endo group (epi group: 240 ± 49 ms vs endo group: 153 ± 45 ms; P = 0.002) and the duration from the onset to the peak of VEGM was also longer than that of the endo group (epi group: 153 ± 53 ms vs endo group: 63 ± 28 ms; P < 0.001). There was no difference in the V wave duration in tip-ring EGM between both groups (epi group: 122 ± 52 ms vs endo group: 98 ± 6 ms; P = 0.377).
Evaluation of intracardiac VEGM before VT ablation may be helpful to predict the epicardial origin of VT in patients with an ICD.
虽然 12 导联心电图的特征性波形已被报道可预测室性心动过速（VT）的心外膜起源，但尚未充分研究通过遥测记录的植入式心脏复律除颤器（ICD）心内电图（VEGM）是否可确定 VT 的起源。本研究旨在探讨源自心外膜的 VT 的 VEGM 特征。
在 46 例患者中，有 15 例（23 次 VT）在 VT 研究期间记录到诱发性 VT 的心内 VEGM，并记录到起源部位。使用通过遥测记录的远场和近场 VEGM 评估 23 次 VT 的特征。在 23 次 VT 中，有 5 次被发现集中在心外膜部位（心外膜组），18 次 VT 集中在心内膜部位（心内膜组）。心外膜组的远场 ECG 中 VT 的 VEGM 持续时间长于心内膜组（心外膜组：240±49 ms 比心内膜组：153±45 ms；P=0.002），从起始到 VEGM 峰值的持续时间也长于心内膜组（心外膜组：153±45 ms 比心内膜组：63±28 ms；P<0.001）。两组间尖端环电极心电图的 V 波持续时间无差异（心外膜组：122±52 ms 比心内膜组：98±6 ms；P=0.377）。
在 VT 消融前评估心内 VEGM 可能有助于预测 ICD 患者 VT 的心外膜起源。
