Waxman H L, Josephson M E
Am J Cardiol. 1982 Jul;50(1):1-10. doi: 10.1016/0002-9149(82)90002-9.
The QRS configuration produced by pacing at multiple left ventricular endocardial sites was evaluated in eight patients with (group 1) and six patients without (group 2) left ventricular wait motion abnormalities. Pacing was performed at a total of 122 sites, 4 to 13 sites in each patient. The QRS configuration resulting from apical pacing locations was compared with that at basal, septal to lateral and inferior to superior locations. Significant differences in QRS configuration during pacing from apical and basal locations were observed in electrocardiographic leads I, V1, V2 and V6 (probability [p] less than 0.01). Specifically, a QS pattern in leads I, V2 and V6 was more characteristic of an apical pacing location (p less than 0.001), and a monophasic R wave in leads V1 and V2 was more characteristic of a basal pacing location (p less than 0.01). Significant differences in leads V1 and V2 were observed when septal and lateral pacing sites were compared (p less than 0.001). A monophasic R wave in leads V1 and V2 was more characteristic of a lateral pacing location (p less than 0.01); a QS complex in lead V2 was more characteristic of a septal pacing location (p less than 0.001). Pacing at superior sites usually produced an inferior axis and vice versa (p less than 0.001). The electrocardiographic patterns produced by pacing at similar sites in patients in group 1 were less consistent than those in patients in group 2. The QRS complex during ventricular pacing was wider in patients in group 1 (159 +/- 30 ms) than in patients in group 2 (132 +/- 18 ms) (p less than 0.001). It is concluded that the QRS configuration recorded with 12 lead electrocardiography during endocardial pacing can help locate the region of the pacing site in patients with and without organic heart disease, although precise localization is not possible.
在8例有左心室壁运动异常（第1组）和6例无左心室壁运动异常（第2组）的患者中，评估了在多个左心室内膜部位起搏所产生的QRS形态。总共在122个部位进行了起搏，每位患者4至13个部位。将心尖部起搏位置产生的QRS形态与基底部、间隔至侧壁以及下至上部位置的QRS形态进行比较。在心电图导联I、V1、V2和V6中观察到，在心尖部和基底部位置起搏期间QRS形态存在显著差异（概率[p]小于0.01）。具体而言，导联I、V2和V6中的QS波型更具心尖部起搏位置的特征（p小于0.001），导联V1和V2中的单相R波更具基底部起搏位置的特征（p小于0.01）。比较间隔和侧壁起搏部位时，在导联V1和V2中观察到显著差异（p小于0.001）。导联V1和V2中的单相R波更具侧壁起搏位置的特征（p小于0.01）；导联V2中的QS波群更具间隔起搏位置的特征（p小于0.001）。在上部位置起搏通常产生下轴，反之亦然（p小于0.001）。第1组患者在相似部位起搏所产生的心电图模式比第2组患者的更不一致。第1组患者心室起搏期间的QRS波群（159±30毫秒）比第2组患者（132±18毫秒）更宽（p小于0.001）。得出结论，尽管无法进行精确定位，但在有或无器质性心脏病的患者中，心内膜起搏期间用12导联心电图记录的QRS形态有助于确定起搏部位的区域。
