Damle R S, Choe W, Kanaan N M, Ehlert F A, Goldberger J J, Kadish A H
Department of Medicine, Northwestern University Medical School, Chicago, Illinois.
J Am Coll Cardiol. 1994 Mar 1;23(3):684-92. doi: 10.1016/0735-1097(94)90755-2.
The purpose of this study was to utilize vector mapping to investigate atrial and accessory pathway activation direction during orthodromic supraventricular tachycardia.
Although advances have been made in the electrophysiologic evaluation and management of accessory pathways, our understanding of accessory pathway anatomy and physiology remains incomplete. Vector mapping has been validated as a method of studying local myocardial activation.
In 28 patients with a left-sided or posteroseptal accessory atrioventricular (AV) pathway referred for ablation, atrial and accessory AV pathway activation direction was determined during ventricular pacing or orthodromic supraventricular tachycardia, or both, by summing three orthogonally oriented bipolar electrograms recorded from the coronary sinus to create three-dimensional vector loops. Atrial and accessory AV pathway activation direction was determined in all patients from the maximal amplitude vectors of the vector loops. Because of beat to beat variability in the directions of the vector loops, data from 8 of 28 patients could not be analyzed.
At 81 of 83 sites, atrial activation direction along the long axis of the coronary sinus corresponded with the direction suggested by activation time mapping. Activation direction along the anteroposterior and inferosuperior axes was variable, potentially due to variations in the level of the atrial insertion of the accessory AV pathway and in the depth or angling of pathway fibers in the AV fat pad. In eight patients, at least one recording was obtained at the site of an accessory AV pathway potential. Accessory AV pathway activation proceeded superiorly and to the right in seven of eight patients; in one patient with a posteroseptal pathway, accessory AV pathway activation proceeded superiorly and to the left.
本研究旨在利用向量标测技术，研究顺向型室上性心动过速时心房和旁路的激动方向。
尽管在旁路的电生理评估和治疗方面已取得进展，但我们对旁路的解剖和生理的理解仍不完整。向量标测已被证实是一种研究局部心肌激动的方法。
对28例因左侧或后间隔旁路拟行消融术的患者，在心室起搏或顺向型室上性心动过速或两者同时进行时，通过对从冠状窦记录的三个相互垂直的双极电图求和，以创建三维向量环，从而确定心房和旁路的激动方向。从向量环的最大振幅向量确定所有患者的心房和旁路激动方向。由于向量环方向逐搏变化，28例患者中的8例数据无法分析。
在83个部位中的81个部位，沿冠状窦长轴的心房激动方向与激动时间标测所提示的方向一致。沿前后轴和上下轴的激动方向各不相同，这可能是由于旁路心房插入部位的水平以及房室脂肪垫中旁路纤维的深度或角度不同所致。在8例患者中，至少在旁路电位部位获得了一次记录。8例患者中有7例旁路激动向上并向右；1例后间隔旁路患者，旁路激动向上并向左。
1）向量标测是定位旁路的一种有用技术；2）左侧旁路在穿过房室沟时从左向右成角；3）冠状窦附近心房肌激动方向的变化表明，旁路在心房的插入部位因人而异。
