Harris L, Downar E, Mickleborough L, Shaikh N, Parson I
Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1987 Nov;10(5):1040-7. doi: 10.1016/s0735-1097(87)80344-3.
Thirty-five patients with ischemic heart disease and ventricular arrhythmias underwent intraoperative activation mapping at the time of coronary artery bypass surgery. During ventricular tachycardia, the sequence of activation in the intact ventricle was recorded simultaneously from 110 endocardial or 110 epicardial sites, or both. A balloon array of electrodes, inserted across the mitral valve, was used to obtain endocardial recordings in the left ventricle, and this appeared to facilitate the induction of ventricular tachycardia. Of 61 episodes of tachycardia, 16 (15 patients) were recorded with the epicardial sock and 45 (20 patients) with the additional use of the endocardial balloon. The sequence of activation during tachycardia was observed to conform to one of four configurations: monoregional spread was the most common activation sequence recorded on both the endocardium and epicardium, while biregional activation and figure eight sequences were recorded exclusively on the epicardium and endocardium, respectively. The fourth sequence was a circular spread of activation observed on both surfaces. Continuous activation throughout the tachycardia cycle length was an infrequent finding. Simultaneous recordings of endocardial and epicardial activation were obtained in 45% of episodes. The sequence of activation recorded on one surface was matched by a similar sequence on the remaining surface in less than half of these. The onset of endocardial activation preceded that of the epicardium in greater than 90% of tachycardia episodes, and the duration of left ventricular endocardial excitation often exceeded that recorded epicardially over both ventricles. The epicardium, however, did appear to be an important determinant of surface electrocardiographic configuration.
35例患有缺血性心脏病和室性心律失常的患者在冠状动脉搭桥手术时进行了术中激动标测。在室性心动过速期间，同时从110个心内膜或110个心外膜部位或两者记录完整心室的激动顺序。通过跨二尖瓣插入的球囊电极阵列来获取左心室的心内膜记录，这似乎有助于诱发室性心动过速。在61次心动过速发作中，16次（15例患者）用心外膜套标测记录，45次（20例患者）额外使用心内膜球囊进行记录。观察到心动过速期间的激动顺序符合四种构型之一：单区域传播是在心内膜和心外膜记录到的最常见激动顺序，而双区域激动和8字形顺序分别仅在心外膜和心内膜记录到。第四种顺序是在两个表面都观察到的激动的环形传播。在整个心动过速周期长度内持续激动是一个不常见的发现。45%的发作获得了心内膜和心外膜激动的同步记录。在这些记录中，不到一半的情况下，一个表面记录的激动顺序与另一个表面的类似顺序相匹配。在超过90%的心动过速发作中，心内膜激动的起始先于心外膜，并且左心室心内膜兴奋的持续时间常常超过在心外膜记录到的两个心室的持续时间。然而，心外膜似乎确实是体表心电图构型的一个重要决定因素。
