Cowan J C, Hilton C J, Griffiths C J, Tansuphaswadikul S, Bourke J P, Murray A, Campbell R W
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne.
Br Heart J. 1988 Nov;60(5):424-33. doi: 10.1136/hrt.60.5.424.
Epicardial activation and repolarisation sequences were investigated in patients with upright or inverted T waves in left ventricular leads of the surface electrocardiogram. Fifteen patients were studied: 10 were undergoing coronary artery bypass grafting (upright T waves) and five aortic valve replacement (four patients with T inversion). Monophasic action potentials were recorded intraoperatively from eight to 10 left ventricular sites in each patient. In patients with upright T waves there was an inverse relation between the duration of the monophasic action potential and the activation time (mean slope -1.44). As a consequence, activation and repolarisation proceeded in opposite directions. Dispersion of repolarisation time (14 ms) was less than dispersion of activation time (23 ms). In patients with T wave inversion caused by aortic stenosis there was no relation between the duration of action potential and activation time; the repolarisation sequence resembled the activation sequence, and the dispersion of repolarisation time was greater than the dispersion of activation time (31 and 26 ms respectively). These results show that there are epicardial repolarisation gradients in man and that these are related to the configuration of the T wave. In patients with upright T waves an inverse relation between the duration of the action potential and the activation time reduces the dispersion of the repolarisation time. When the T wave was inverted this relation was no longer found and the dispersion of repolarisation increased.
在体表心电图左心室导联T波直立或倒置的患者中，研究了心外膜激动和复极顺序。共研究了15例患者：10例正在接受冠状动脉搭桥手术（T波直立），5例接受主动脉瓣置换术（4例T波倒置）。术中在每位患者的8至10个左心室部位记录单相动作电位。在T波直立的患者中，单相动作电位持续时间与激动时间呈负相关（平均斜率-1.44）。因此，激动和复极方向相反。复极时间离散度（14毫秒）小于激动时间离散度（23毫秒）。在主动脉瓣狭窄导致T波倒置的患者中，动作电位持续时间与激动时间无关；复极顺序类似于激动顺序，复极时间离散度大于激动时间离散度（分别为31和26毫秒）。这些结果表明，人体存在心外膜复极梯度，且这些梯度与T波形态有关。在T波直立的患者中，动作电位持续时间与激动时间的负相关减少了复极时间的离散度。当T波倒置时，这种关系不再存在，复极离散度增加。
