Stevenson W G, Wiener I, Weiss J N
Am J Cardiol. 1986 Mar 1;57(8):582-6. doi: 10.1016/0002-9149(86)90839-8.
Anodal excitation may contribute to the initiation of ventricular arrhythmias during bipolar pacing in the canine ventricle. To determine if anodal excitation occurs during bipolar programmed ventricular stimulation in humans, ventricular electrograms adjacent to the anode and cathode were recorded using a specially designed hexapolar electrode catheter in 10 patients. Single extrastimuli were delivered during ventricular pacing at stimulus strengths slightly above the late diastolic threshold and at 2 to 5 times late diastolic threshold. Evidence of anodal excitation was observed in 18 of the 52 combinations (35%) of stimulus strengths and electrode configurations tested, and occurred in 9 of the 10 patients; it consisted of earliest ventricular activation adjacent to the anode (8 patients) or simultaneous activation at the anode and cathode (3 patients). This occurred either with premature stimuli (3 patients) or during the basic drive and extrastimuli (6 patients). Comparison of local activation times during unipolar pacing supported an anodal contribution to excitation during bipolar pacing and suggested that inhomogenous conduction delays were not responsible for these findings. Thus, anodal excitation occurs frequently during bipolar programmed stimulation and produces marked changes in local myocardial activation, which may potentially influence the initiation of ventricular arrhythmias.
在犬类心室双极起搏过程中，阳极兴奋可能促使室性心律失常的发生。为确定在人体双极程控心室刺激过程中是否会出现阳极兴奋，我们使用特制的六极电极导管，对10例患者记录了阳极和阴极附近的心室电图。在心室起搏期间，以略高于舒张末期阈值以及舒张末期阈值2至5倍的刺激强度发放单个额外刺激。在所测试的52种刺激强度与电极配置组合中，有18种（35%）观察到了阳极兴奋的证据，且10例患者中有9例出现；表现为阳极附近最早的心室激动（8例患者）或阳极与阴极同时激动（3例患者）。这一现象出现在提前刺激时（3例患者）或基础驱动及额外刺激期间（6例患者）。单极起搏期间局部激动时间的比较支持了阳极兴奋在双极起搏过程中的作用，并表明不均匀传导延迟并非这些结果的原因。因此，在双极程控刺激期间，阳极兴奋频繁发生，并导致局部心肌激动发生显著变化，这可能会对室性心律失常的发生产生潜在影响。
