Pannizzo F, Mercando A D, Fisher J D, Furman S
Department of Surgery, Montefiore Medical Center, Bronx, New York.
J Am Coll Cardiol. 1988 Feb;11(2):308-16. doi: 10.1016/0735-1097(88)90095-2.
Electrical devices play an increasingly important role in the control of tachyarrhythmias. Antitachycardia pacing and automatic defibrillation have been severely limited by the poor specificity of tachycardia discrimination in commercially available devices. Although absolute heart rate has been the principal means of automatic diagnosis, several new detection algorithms and methods are being investigated. Multiple electrode timing comparison, signal processing and pattern recognition are employed in these newer techniques. Although each offers some improvement over present technology, none is capable of identifying all arrhythmias. The methods employing comparison of atrial and ventricular rates, without additional criteria, are unable to detect ventricular tachycardia in the presence of 1:1 retrograde conduction. Electrographic analysis techniques require very stable electrodes and may not tolerate normal morphologic variations. A combination of two or more approaches may ultimately be required. All techniques will require that certain critical variables be programmable to allow for individualization in each clinical situation. Soft-ware-controllable devices and those capable of sensing from both the atria and the ventricles will provide the sophistication necessary for the implementation of complex tachycardia detection algorithms. This report reviews automatic tachycardia detection techniques in current use and under investigation.
电气设备在快速性心律失常的控制中发挥着越来越重要的作用。抗心动过速起搏和自动除颤受到市售设备中心动过速鉴别特异性差的严重限制。尽管绝对心率一直是自动诊断的主要手段，但目前正在研究几种新的检测算法和方法。这些更新的技术采用了多电极定时比较、信号处理和模式识别。虽然每种技术都比现有技术有所改进，但没有一种能够识别所有的心律失常。采用心房率和心室率比较而无其他标准的方法，在存在1:1逆向传导时无法检测到室性心动过速。心电图分析技术需要非常稳定的电极，并且可能无法耐受正常的形态学变化。最终可能需要两种或更多方法的组合。所有技术都需要某些关键变量可编程，以便在每种临床情况下实现个体化。软件可控设备以及能够从心房和心室进行感知的设备，将为实施复杂的心动过速检测算法提供必要的精密性。本报告回顾了目前正在使用和研究中的自动心动过速检测技术。
