Asano Y, Izumida N, Kiyohara K, Hosaki J, Kawano S, Sawanobori T, Hiraoka M
Department of Pediatrics, School of Medicine, Tokyo Medical and Dental University, Japan.
J Electrocardiol. 1995 Jul;28(3):209-21. doi: 10.1016/s0022-0736(05)80259-6.
The utility of body surface QRST isointegral maps (QRST-Imaps) for the detection of right ventricular (RV) overload was examined in children with postoperative development of right bundle branch block. In healthy children with no evidence of bundle branch block (n = 31), the QRST-Imap demonstrated a maximum at the left anterior chest and a minimum near the right shoulder with a single dipole distribution. The positive areas extended from the left anterior chest to the left back, and negative areas extended from the right anterior chest to the right back. Children with complete right bundle branch block but without heart disease demonstrated a QRST-Imap that was similar to that seen in normal children. In patients with RV overload (n = 15; 8 with ventricular septal defect and complicated anomaly and 7 with tetralogy of Fallot), the QRST-Imaps were abnormal and demonstrated double maxima, a rightward shift of the maximum, and extension of positive areas to the right chest. In the 10 patients who developed postoperative complete right bundle branch block, 4 had no evidence of RV overload by hemodynamic or echocardiographic assessment and demonstrated a normal QRST-Imap. In the six children who had residual RV overload during hemodynamic assessment, the QRST-Imap was abnormal. These results suggest that the QRST-Imap is a useful method for the detection of RV overload in pediatric patients complicated with conduction disturbances.
在术后发生右束支传导阻滞的儿童中，研究了体表QRST等积分图（QRST-Imaps）检测右心室（RV）超负荷的效用。在无束支传导阻滞证据的健康儿童（n = 31）中，QRST-Imap显示在左前胸有最大值，在右肩附近有最小值，呈单偶极子分布。正区从左前胸延伸至左背部，负区从右前胸延伸至右背部。完全性右束支传导阻滞但无心脏病的儿童显示的QRST-Imap与正常儿童相似。在RV超负荷的患者中（n = 15；8例患有室间隔缺损合并复杂畸形，7例患有法洛四联症），QRST-Imaps异常，显示有两个最大值、最大值向右移位以及正区延伸至右胸。在术后发生完全性右束支传导阻滞的10例患者中，4例经血流动力学或超声心动图评估无RV超负荷证据，其QRST-Imap显示正常。在血流动力学评估时有残余RV超负荷的6例儿童中，QRST-Imap异常。这些结果表明，QRST-Imap是检测合并传导障碍的儿科患者RV超负荷的一种有用方法。
