Wahlers T, Haverich A, Schäfers H J, Frimpong-Boateng K, Fieguth H G, Hermann G, Borst H G, Arvanitidou V
J Heart Transplant. 1986 Nov-Dec;5(6):450-4.
Heart transplantation, including conventional immunosuppression, has allowed the use of the surface electrocardiogram to detect allograft rejection. With the use of cyclosporine this parameter is no longer sensitive, but voltage of the intramyocardial electrogram has correlated repeatedly with rejection. From July 1983 through February 1986, 98 patients had heart transplantation; 13 of those patients had a telemetry pacemaker simultaneously implanted. In previous studies, daytime dependent variabilities of the sum voltage of the surface electrocardiogram were reported. Therefore intramyocardial electrogram was measured at 7, 10, 13, 16, and 20 hours. In addition, the influence of exercise on intramyocardial electrogram voltage was studied in all patients. Analysis of the diurnal intramyocardial electrogram revealed substantial atrial and ventricular variability of both voltage measurements (p less than 0.05). Also, intramyocardial electrogram voltage was influenced by exercise, as demonstrated by a significant decrease after physical work at 25 W (-8%) and 50 W (-12%); p less than 0.05. Therefore we conclude that a high variability of intramyocardial electrogram may be found diurnally and on exercise testing after heart transplantation in humans. If intramyocardial electrogram is used to detect rejection, it should be applied at comparable hours and with the patients in a controlled resting state.
心脏移植，包括传统的免疫抑制治疗，使得利用体表心电图来检测移植心脏排斥反应成为可能。随着环孢素的应用，这一参数不再敏感，但心肌内心电图的电压却反复与排斥反应相关。从1983年7月至1986年2月，98例患者接受了心脏移植；其中13例患者同时植入了遥测起搏器。在以往的研究中，曾报道过体表心电图总电压的日间依赖性变化。因此，在7、10、13、16和20小时测量心肌内心电图。此外，还对所有患者进行了运动对心肌内心电图电压影响的研究。对日间心肌内心电图的分析显示，两种电压测量的心房和心室均存在显著变化（p<0.05）。而且，心肌内心电图电压受运动影响，在25W（-8%）和50W（-12%）体力活动后显著下降，证实了这一点；p<0.05。因此，我们得出结论，在人类心脏移植后，日间和运动试验时心肌内心电图可能存在高度变异性。如果用心肌内心电图来检测排斥反应，应在可比的时间进行，且患者处于受控的静息状态。
