Josephson M E, Horowitz L N, Farshidi A, Spear J F, Kastor J A, Moore E N
Circulation. 1978 Mar;57(3):440-7. doi: 10.1161/01.cir.57.3.440.
Endocardial ventricular mapping of 21 ventricular tachyardias (VT) in 17 patients was performed using electrode catheters. Activation at multiple left and right ventricular sites was utilized to determine the site of origin of the VT. Eleven VT had a left bundle branch block pattern (VT-LBBB) and 10 VT had right bundle branch block pattern (VT-RBBB). In all VT-RBBB the earliest site of activation was in the LV or septum. In VT-LBBB the earliest site was RV (4/11), LV (5/11) and septum (2/11). All ventricular tachycardias with QRS less than 140 msec arose in the septum. In patients with an aneurysm, the site of origin of ventricular tachycardia was always in the aneursm. All VT-LBBB arising from the left ventricle originated in an aneurysm involving the septum. QRS changes during ventricular tachycardia were associated with alterations in the patterm of ventricular activation without alteration of the site of origin. In three patients the site of origin predicted by endocardial ventricular mapping was confirmed intraoperatively by epi- and/or endocardial mapping. We conclude that endocardial ventricular mapping demonstrates the limitations of the surface electrocardiogram in localizing the site of origin of ventricular tachycardia. The method may provide important data upon which the surgical therapy of ventricular tachycardia is based.
使用电极导管对17例患者的21次室性心动过速（VT）进行心内膜心室标测。利用左、右心室多个部位的激动来确定室性心动过速的起源部位。11次室性心动过速呈左束支传导阻滞图形（VT-LBBB），10次室性心动过速呈右束支传导阻滞图形（VT-RBBB）。在所有VT-RBBB中，最早激动部位位于左心室或室间隔。在VT-LBBB中，最早激动部位为右心室（4/11）、左心室（5/11）和室间隔（2/11）。所有QRS波时限小于140毫秒的室性心动过速均起源于室间隔。在有室壁瘤的患者中，室性心动过速的起源部位总是在室壁瘤内。所有起源于左心室的VT-LBBB均起源于累及室间隔的室壁瘤。室性心动过速期间的QRS波变化与心室激动模式的改变有关，而起源部位未改变。在3例患者中，心内膜心室标测预测的起源部位在术中通过心外膜和/或心内膜标测得到证实。我们得出结论，心内膜心室标测显示了体表心电图在定位室性心动过速起源部位方面的局限性。该方法可为室性心动过速的外科治疗提供重要的数据基础。
