Klug D, Ferracci A, Molin F, Dubuc M, Savard P, Kus T, Hélie F, Cardinal R, Nadeau R
Research Center, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.
Circulation. 1995 Apr 1;91(7):2002-9. doi: 10.1161/01.cir.91.7.2002.
The purpose of this report is to describe the body surface potential maps (BSPMs) during idiopathic ventricular tachycardia (VT) and to determine what differences exist between different idiopathic VT morphologies.
We performed BSPMs during VT on 12 consecutive patients (3 women and 9 men; mean age, 42 +/- 13 years) presenting symptomatic idiopathic VT referred to our institution for electrophysiological study. Basal ECG, chest radiograph, and echocardiogram were normal in all patients. Clinical tachycardia showed left bundle branch block pattern (LBBB) in 9 patients, with sustained VT in 5 and nonsustained VT in 4, and right bundle branch block pattern (RBBB) in 3 with sustained VT. We found a unique pattern of BSPMs in each of the 9 patients during idiopathic LBBB VT configuration, whether sustained or nonsustained VT. This pattern appeared at the onset of the QRS and remained stable during the whole QRS complex. The area of minimal potential located in the upper anterior part of the torso was compatible with an origin of VT in the right ventricular outflow tract, as confirmed in 5 patients by successful radiofrequency ablation. We found an evolving pattern with two phases in each of the three RBBB VTs. The electrical axis during the initial part of the QRS could correspond to an endocardial-epicardial vector. The second phase, with a high voltage and area of minimal potential located in the inferior and anterior part of the torso, was compatible with a left ventricular apical origin that was confirmed by epicardial and endocardial mapping during cryosurgery in 1 patient. For all the VTs, the QRS isoarea maps showed the same pattern as the second phase of the QRS.
Two different BSPM patterns were found. All LBBB VTs had the same stable pattern corresponding to an infundibular origin. All RBBB VTs had an evolving pattern that stabilized in the second part of the QRS complex corresponding to an apical origin.
本报告旨在描述特发性室性心动过速（VT）期间的体表电位图（BSPM），并确定不同特发性VT形态之间存在哪些差异。
我们对连续12例因症状性特发性VT前来我院进行电生理研究的患者（3名女性和9名男性；平均年龄42±13岁）在VT期间进行了BSPM检查。所有患者的基础心电图、胸部X线片和超声心动图均正常。临床心动过速表现为左束支传导阻滞图形（LBBB）的有9例患者，其中持续性VT 5例，非持续性VT 4例；表现为右束支传导阻滞图形（RBBB）的有3例患者，均为持续性VT。我们发现，在9例特发性LBBB VT形态的患者中，无论VT是持续性还是非持续性，每例患者的BSPM都有独特的图形。这种图形在QRS波起始时出现，并在整个QRS波群期间保持稳定。位于躯干上前部的最小电位区域与右心室流出道VT起源相符，5例患者经成功的射频消融证实。我们发现3例RBBB VT中的每例都有一个分两个阶段演变的图形。QRS波初始部分的电轴可能对应于心内膜-心外膜向量。第二阶段，高电压和最小电位区域位于躯干下部和前部，与左心室心尖起源相符，1例患者在冷冻手术期间经心外膜和心内膜标测证实。对于所有VT，QRS等面积图显示的图形与QRS波的第二阶段相同。
发现了两种不同的BSPM图形。所有LBBB VT都有相同的稳定图形，对应于漏斗部起源。所有RBBB VT都有一个演变的图形，在QRS波群的第二部分稳定下来，对应于心尖起源。
