van der Schaaf I, Kloosterman M, Gorgels A P M, Loh P, van Dam P M
Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
J Electrocardiol. 2024 Mar-Apr;83:50-55. doi: 10.1016/j.jelectrocard.2024.01.007. Epub 2024 Jan 27.
CineECG offers a visual representation of the location and direction of the average ventricular electrical activity throughout a single cardiac cycle, based on the 12‑lead ECG. Currently, CineECG has not been used to visualize ventricular activation patterns during ischemia.
To determine the changes in ventricular activity during acute ischemia with the use of CineECG, and relating this to changes in the ECG.
Continuous ECG's during percutaneous coronary intervention with prolonged balloon inflation from the STAFF III database were analyzed with CineECG at baseline and every 10 s throughout the first 150 s of balloon inflation. The CineECG direction was determined for the initial QRS-complex, terminal QRS-complex, ST-segment and T-wave. Changes in the CineECG were quantified by calculating the Δangle between the direction at baseline and the direction at every 10 s of inflation. Additionally, the root mean square amplitude (rmsA) of the ST-segment was computed.
94 patients were included. At start inflation, the median Δangle was 14.7° [7.5-33.4], 21.8° [11.4-34.2], 20.6° [8.0-43.9], and 23.5° [11.8-48.0] for the initial QRS-complex, terminal QRS-complex, ST-segment and T-wave, respectively. Meanwhile, the median rmsA increased from 0.039 mV [0.027-0.058] at baseline to 0.045 mV [0.033-0.075] at start of inflation.
CineECG was able to detect immediate changes in ventricular electrical activity during induced ischemia, while changes in the ST-segment of the ECG were still subtle. Therefore, CineECG might support the early detection of acute ischemia, even before distinct ECG changes become visible.
动态心电图（CineECG）基于12导联心电图，提供了整个心动周期中心室平均电活动的位置和方向的直观表示。目前，CineECG尚未用于可视化缺血期间的心室激活模式。
使用CineECG确定急性缺血期间心室活动的变化，并将其与心电图变化相关联。
对STAFF III数据库中经皮冠状动脉介入治疗期间延长球囊扩张时的连续心电图，在基线时以及球囊扩张的前150秒内每10秒用CineECG进行分析。确定初始QRS波群、终末QRS波群、ST段和T波的CineECG方向。通过计算基线方向与每次扩张10秒时方向之间的Δ角度来量化CineECG的变化。此外，计算ST段的均方根振幅（rmsA）。
纳入94例患者。在开始扩张时，初始QRS波群、终末QRS波群、ST段和T波的中位Δ角度分别为14.7°[7.5-33.4]、21.8°[11.4-34.2]、20.6°[8.0-43.9]和23.5°[11.8-48.0]。同时，中位rmsA从基线时的0.039mV[0.027-0.058]增加到扩张开始时的0.045mV[0.033-0.075]。
CineECG能够检测到诱导缺血期间心室电活动的即时变化，而心电图ST段的变化仍然不明显。因此，CineECG可能有助于急性缺血的早期检测，甚至在明显的心电图变化出现之前。
