Préda I, Nadeau R, Savard P, Hamel D, Palisaitis D, Shenasa M, Nasmith J
Research Center, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.
J Electrocardiol. 1994 Oct;27(4):311-22. doi: 10.1016/s0022-0736(05)80269-9.
Body surface QRS potentials were recorded with 63 chest leads in 20 patients with proximal single-vessel disease located on either the left anterior descending coronary artery (n = 10), the right coronary artery (n = 6), or the left circumflex coronary artery (n = 4) before, during, and after percutaneous transluminal coronary angioplasty. In each case, three consecutive inflations of relatively short duration (37 +/- 14 seconds) were carried out. Electrical activity was displayed as unipolar electrograms and body surface potential maps. The total QRS complex duration decreased in 14 of the 20 patients. Focal conduction disturbances were observed in six cases; all six had left anterior descending coronary artery occlusion and two were also accompanied by a clear shortening of the right epicardial breakthrough time. In these two cases, an initial activation loss seemed to be characteristic, whereas in the other four cases, a rather diffuse slowing of intraventricular conduction, especially during the terminal portion of the QRS, could be observed. Individual and group mean isointegral difference body surface potential maps (during-minus-before dilation) were considered valuable for the interpretation of localized changes in intraventricular conduction during percutaneous transluminal coronary angioplasty, and their individual variations could, at least partly, be explained by the presence or absence of collateral circulation. Two different hypotheses are suggested to account for the QRS complex shortening observed during short-term myocardial ischemic injury: (1) coronary artery occlusion delayed activation of the portion of the septal region that is normally activated early during the QRS, and/or (2) coronary artery occlusion increased the speed of propagation within the ventricles. Both of these hypotheses are discussed in light of earlier clinical and experimental results.
对20例近端单支血管病变患者进行经皮腔内冠状动脉成形术，术前、术中和术后用63个胸导联记录体表QRS电位。病变血管位于左前降支冠状动脉（n = 10）、右冠状动脉（n = 6）或左旋支冠状动脉（n = 4）。每种情况下，进行三次持续时间相对较短（37±14秒）的连续扩张。电活动显示为单极电图和体表电位图。20例患者中有14例的QRS波群总时限缩短。观察到6例局灶性传导障碍；所有6例均为左前降支冠状动脉闭塞，其中2例还伴有右心外膜突破时间明显缩短。在这2例中，初始激活丧失似乎是其特征，而在其他4例中，可观察到室内传导明显弥漫性减慢，尤其是在QRS波群的终末部分。个体和组平均等积分差体表电位图（扩张期间减去扩张前）对解释经皮腔内冠状动脉成形术期间室内传导的局部变化很有价值，其个体差异至少部分可由侧支循环的存在与否来解释。提出了两种不同的假说来解释短期心肌缺血损伤期间观察到的QRS波群缩短：（1）冠状动脉闭塞延迟了正常在QRS波群早期激活的间隔区域部分的激活，和/或（2）冠状动脉闭塞增加了心室内的传导速度。根据早期临床和实验结果对这两种假说进行了讨论。
