Kitamura K, Tsujimura Y, Hirano M, Morikawa J, Tanaka N, Takeda H, Hamamoto H, Nishimoto Y, Takanashi T
Department of Laboratory Medicine, Kyoto Prefectural University of Medicine, Japan.
J Electrocardiol. 1988 Jan;21(1):65-70. doi: 10.1016/s0022-0736(88)80025-6.
A clinical evaluation of the surface-averaged ECG (SAE) to record His-Purkinje activity (HPA) was made on 70 patients who underwent His bundle electrograms (HBE). The recorded signals first judged as HPA in 43 patients by the noninvasive method alone were later verified in 37 patients by HBE; the accuracy of the HPA recordings (predictive value) was 86.0%. The HPA-V interval measured noninvasively had a high correlation with the HV interval by HBE (r = 0.89, p less than 0.01). The verified detection rate in all 70 patients was 52.9%: HPA was detected in 12 of 18 patients (66.7%) with sclerotic and hypertensive heart disease (Group I), five of 19 patients (26.3%) with rheumatic heart disease (Group II), 11 of 17 patients (64.7%) with congenital heart disease (Group III), and nine of 16 patients (56.2%) with miscellaneous conditions (Group IV). The detection rate was markedly lower in Group II than in other groups (Group II vs Group I or III, p less than 0.025). The PR segment was significantly longer in the patients in whom HPA was detected than in those in whom it was not detected (71.5 +/- 22.3 msec vs 43.9 +/- 19.5 msec, p less than 0.001). His-Purkinje activity (HPA) was detected in 32 of 52 recordings (61.5%) with sinus rhythm and seven of 20 recordings (35.0%) with atrial fibrillation, including two recordings in each of two cardioverted patients (p less than 0.05). We conclude that the surface-averaged ECG (SAE) has clinically acceptable sensitivity and accuracy except in patients with rheumatic heart disease, short PR segments or atrial fibrillations.
对70例行希氏束电图（HBE）检查的患者进行了体表平均心电图（SAE）记录希氏 - 浦肯野系统活动（HPA）的临床评估。仅通过无创方法最初判定为有HPA的43例患者中，后来经HBE证实有37例；HPA记录的准确性（预测值）为86.0%。无创测量的HPA - V间期与HBE测量的HV间期高度相关（r = 0.89，p＜0.01）。70例患者中经证实的检出率为52.9%：在18例硬化性和高血压性心脏病患者（I组）中有12例（66.7%）检测到HPA，19例风湿性心脏病患者（II组）中有5例（26.3%），17例先天性心脏病患者（III组）中有11例（64.7%），16例其他病症患者（IV组）中有9例（56.2%）。II组的检出率明显低于其他组（II组与I组或III组相比，p＜0.025）。检测到HPA的患者的PR段明显长于未检测到HPA的患者（71.5±22.3毫秒对43.9±19.5毫秒，p＜0.001）。在52次窦性心律记录中有32次（61.5%）检测到希氏 - 浦肯野系统活动（HPA），在20次心房颤动记录中有7次（35.0%）检测到，其中包括2例复律患者各有2次记录（p＜0.05）。我们得出结论，体表平均心电图（SAE）具有临床上可接受的敏感性和准确性，但风湿性心脏病、PR段短或心房颤动患者除外。
