Lemery R, Hammill S C, Wood D L, Danielson G K, Mankin H T, Osborn M J, Gersh B J, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Br Heart J. 1987 Oct;58(4):324-32. doi: 10.1136/hrt.58.4.324.
The resting 12 lead electrocardiogram and vectocardiogram were reviewed in 47 patients with the Wolff-Parkinson-White syndrome (a) who had pre-excitation on the resting 12 lead electrocardiogram, (b) who had a single anterograde conducting accessory pathway assessed and located during preoperative electrophysiological study and during epicardial mapping at operation, and (c) in whom surgical division of the accessory pathway resulted in loss of pre-excitation. The site of the accessory pathway established during operation was compared with that established by evaluating the polarity of the delta wave and QRS complex on the resting 12 lead electrocardiogram. The electrocardiogram was assessed by the Rosenbaum criteria (Wolff-Parkinson-White type A, left-sided pathway; or type B, right-sided pathway), the Gallagher criteria (atrial pacing resulting in maximal pre-excitation), and the World Health Organisation criteria (a composite of previous studies). The Gallagher and World Health Organisation criteria were derived from patients demonstrating maximal pre-excitation that often required atrial pacing. The present study was designed to determine whether these criteria could be accurately applied to the resting 12 lead electrocardiogram on which the degree of pre-excitation was variable. The Rosenbaum criteria correctly identified a left sided accessory pathway in 26 of 34 patients and a right-sided accessory pathway in nine of 13 patients. The Gallagher and World Health Organisation criteria correctly identified the location in only 15 (32%) of the 47 patients. The resting vectorcardiogram was inaccurate for locating the accessory pathway. Although published criteria are useful for identifying the site of the accessory pathway from an electrocardiogram obtained when rapid atrial pacing is being used to achieve maximal pre-excitation, they are not suitable for identifying the exact site of an accessory pathway from the resting 12 lead electrocardiogram.
对47例预激综合征患者的静息12导联心电图和心向量图进行了回顾性分析，这些患者符合以下条件：(a)静息12导联心电图存在预激；(b)术前电生理研究及术中的心外膜标测评估并定位了单一的顺行传导旁路；(c)手术切断旁路后预激消失。将术中确定的旁路部位与通过评估静息12导联心电图上δ波和QRS波群的极性所确定的部位进行比较。采用罗森鲍姆标准（A型预激综合征，左侧旁路；或B型，右侧旁路）、加拉格尔标准（心房起搏导致最大预激）和世界卫生组织标准（既往研究的综合标准）对心电图进行评估。加拉格尔标准和世界卫生组织标准源自那些常需心房起搏以显示最大预激的患者。本研究旨在确定这些标准能否准确应用于预激程度可变的静息12导联心电图。罗森鲍姆标准在34例患者中正确识别出2个左侧旁路和13例患者中的9个右侧旁路。加拉格尔标准和世界卫生组织标准仅在47例患者中的15例（32%）中正确识别出部位。静息心向量图在定位旁路方面不准确。尽管已发表的标准对于从使用快速心房起搏以实现最大预激时获得的心电图中识别旁路部位有用，但它们不适用于从静息12导联心电图中识别旁路的确切部位。
