Suzuki A, Hirai M, Hayashi H, Ichihara Y, Adachi M, Oguchi S, Nishiyama A, Shimizu S, Watarai M, Shiga Y
First Department of Internal Medicine, University of Nagoya School of Medicine, Japan.
Pacing Clin Electrophysiol. 1993 Apr;16(4 Pt 1):751-9. doi: 10.1111/j.1540-8159.1993.tb01655.x.
To assess the effects of right ventricular (RV) pacing on body surface QRST distributions, we recorded QRST isointegral maps (I-maps) during sinus rhythm and RV pacing in 25 patients with anterior myocardial infarction (MI), 19 with inferior MI, and 14 without MI. The QRST values at each lead point recorded during sinus rhythm and RV pacing with an 87-lead system were analyzed with a paired t-test in each patient. An abnormal decrease in the QRST value of the I-map was assessed by the difference map, which indicated a "-2SD area," where the QRST integral value was less than the normal range (mean - 2SD) calculated from 608 normal individuals. The I-maps were similar during the two activation sequences in patients with and without MI. However, during RV pacing, QRST values significantly decreased over the upper right anterior chest and increased over the lower left anterior chest and back. The sigma DMs (sum of QRST integral values below the normal range) for both activation sequences were strongly correlated in patients with anterior MI and with inferior MI (r = 0.91 and r = 0.92, respectively; P < 0.001). Although small but significant changes in QRST values were detected, the distribution of the "-2SD area" and the sigma DM were similar during both activation sequences in patients with prior MI. Thus, these findings demonstrate that an altered activation sequence produces small but significant changes in QRST values but that I-maps still provide information that is useful for the diagnosis of MI during RV pacing.
为评估右心室（RV）起搏对体表QRST分布的影响，我们记录了25例前壁心肌梗死（MI）患者、19例下壁MI患者和14例无MI患者在窦性心律和RV起搏期间的QRST等积分图（I-图）。使用87导联系统在窦性心律和RV起搏期间记录的每个导联点的QRST值，在每位患者中进行配对t检验分析。通过差异图评估I-图中QRST值的异常降低，差异图显示出一个“-2SD区域”，其中QRST积分值低于根据608名正常个体计算出的正常范围（均值-2SD）。有无MI的患者在两种激动顺序期间的I-图相似。然而，在RV起搏期间，右上前胸的QRST值显著降低，左下前胸和背部的QRST值升高。前壁MI患者和下壁MI患者两种激动顺序的σ DMs（正常范围以下的QRST积分值总和）密切相关（分别为r = 0.91和r = 0.92；P < 0.001）。尽管检测到QRST值有微小但显著的变化，但既往有MI的患者在两种激动顺序期间“-2SD区域”的分布和σ DM相似。因此，这些发现表明，激动顺序改变会导致QRST值出现微小但显著的变化，但I-图在RV起搏期间仍能提供对MI诊断有用的信息。
