Anderson K P, Walker R, Fuller M, Dustman T, Ershler P R, Lux R L
Cardiology Division, University of Utah, Salt Lake City 84132.
IEEE Trans Biomed Eng. 1993 Feb;40(2):169-81. doi: 10.1109/10.212057.
Detection of local electrical myocardial activation by means of extracellular recordings is often difficult in the presence of polyphasic electrograms. The purpose of this investigation was to compare the ability of several variables to distinguish unipolar deflections due to local activation from those due to nonlocal activity. A model of polyphasic deflections based on atrial recordings during reentrant tachycardia was used to facilitate distinction of local and distant activity by methods independent of the test variables. The performance of variables were assessed by comparing areas under receiver operating characteristic curves. Optimal thresholds of test variables were identified by maximizing statistics which corrected for the pretest probability of local activation. We found that the greatest negative first derivative of the unipolar potential discriminated between local and distant ventricular signals, but performed less well than the ratio of the first derivative to the potential for distinguishing between local atrial signals and distant ventricular signals. A linear combination of the potential and the ratio of the first derivative and the potential performed well for all groups of signals studied. We conclude that optimal criteria for detecting local activation depends on the characteristics of the population of signals and that a statistical approach can be used to identify optimal criteria for a given population.
在存在多相电图的情况下，通过细胞外记录检测局部心肌电活动通常很困难。本研究的目的是比较几个变量区分局部激活引起的单极偏转和非局部活动引起的单极偏转的能力。使用基于折返性心动过速期间心房记录的多相偏转模型，通过独立于测试变量的方法来促进局部和远处活动的区分。通过比较接受者操作特征曲线下的面积来评估变量的性能。通过最大化校正局部激活预测试概率的统计量来确定测试变量的最佳阈值。我们发现，单极电位的最大负一阶导数能够区分局部和远处的心室信号，但在区分局部心房信号和远处心室信号方面，其表现不如一阶导数与电位的比值。对于所研究的所有信号组，电位与一阶导数和电位比值的线性组合表现良好。我们得出结论，检测局部激活的最佳标准取决于信号群体的特征，并且可以使用统计方法来确定给定群体的最佳标准。
