van Hemel N M, Swenne C A, Robles de Medina E O
Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
Eur Heart J. 1987 Aug;8(8):813-20. doi: 10.1093/oxfordjournals.eurheartj.a062344.
Mechanisms of ventricular arrhythmias were assessed by the application of ECG criteria derived from experimental electrophysiology. These interval criteria describe for ideal and modulated parasystole, resetable spontaneous automaticity, early and delayed afterdepolarizations and reentry, how QRS complexes of ectopic ventricular origin relate to those of supraventricular origin. Ventricular arrhythmias were studied in: (a) long-term, 1-lead ECG recordings of 85 patients with uncomplicated and untreated acute myocardial infarction (AMI) (group 1); (b) one-hour, 4-lead ECG recordings of 23 comparable patients with AMI (group 2), and (c) one-hour, 4-lead ECG recordings of 10 patients with chronic ventricular arrhythmias (group 3). All QRS complexes of ectopic ventricular origin having identical morphology (V type) were assumed to be the manifestation of a single site in the ventricle. The supraventricular rhythm in groups 2 and 3 was varied by programmed atrial stimulation to increase the range of intervals and patterns of the V types in the ECG. Positive evidence for a particular mechanism was obtained by applying tested criteria in 38% of 263 V types in group 1 (mainly reentry, but also early and delayed afterdepolarizations). In group 2, there was positive evidence in 67% of 84 V types (mainly reentry, but also early and delayed afterdepolarizations) and also in 67% of 18 V types in group 3, (mainly reentry). The application of these ECG criteria to ventricular arrhythmias identifies mechanisms in a satisfactory proportion. The yield can be increased by artificial variation of the heart rate.
通过应用源自实验电生理学的心电图标准来评估室性心律失常的机制。这些间期标准描述了理想和调制的并行心律、可重置的自发自律性、早期和延迟后除极以及折返，异位室性起源的QRS波群与室上性起源的QRS波群之间的关系。对以下情况的室性心律失常进行了研究：(a) 85例无并发症且未经治疗的急性心肌梗死（AMI）患者的长期单导联心电图记录（第1组）；(b) 23例类似AMI患者的1小时四导联心电图记录（第2组），以及(c) 10例慢性室性心律失常患者的1小时四导联心电图记录（第3组）。所有形态相同（V型）的异位室性起源QRS波群均被认为是心室单个部位的表现。通过程控心房刺激改变第2组和第3组的室上性心律，以增加心电图中V型的间期范围和模式。通过对第1组263个V型中的38%应用测试标准获得了特定机制的阳性证据（主要是折返，但也有早期和延迟后除极）。在第2组中，84个V型中的67%有阳性证据（主要是折返，但也有早期和延迟后除极），第3组的18个V型中的67%也有阳性证据（主要是折返）。将这些心电图标准应用于室性心律失常可确定相当比例的机制。通过人为改变心率可提高检出率。
