Kawamura Y, Kikuchi K, Nadeau R, Page P, Cardinal R
First Department of Internal Medicine, Asahikawa Medical College.
J Cardiol. 1995 Dec;26(6):349-55.
This study aimed to elucidate the relationship between the epicardial activation pattern and the site of origin of the ventricular tachycardia (VT) occurring from the interventricular septum, and to find epicardial breakthrough characteristics identifying VT substrates. Seven patients undergoing intraoperative mapping including right ventricular endocardial mapping were studied. Thirteen septal VTs, which were defined as VTs in which both right and left ventricular endocardial breakthroughs were on the septal aspect, were induced. The VT site of origin was identified from the site and timing of right and left septal endocardial breakthroughs. All VTs were classified into three groups according to the site of epicardial breakthrough: type A, epicardial breakthrough in the anterior interventricular area; type F, epicardial breakthrough in the right ventricular free wall; type P, epicardial breakthrough in the posterior interventricular area. All type F VTs had a right ventricular endocardial breakthrough in the anterior septum and preceded the left ventricular endocardial breakthrough, thereby indicating right anterior septal origin. In the types A and P, both the right and left endocardial breakthroughs were localized in consistent (anterior and posterior, respectively) halves of the septum, but their relative timing was inconstant. This result suggests that epicardial mapping, and even noninvasive methods like body surface mapping, can identify the site of origin of the septal VTs, especially when the epicardial breakthrough occurs in the right ventricular free wall.
本研究旨在阐明心外膜激动模式与室间隔起源的室性心动过速（VT）起源部位之间的关系，并寻找识别VT基质的心外膜突破特征。对7例接受术中标测（包括右心室心内膜标测）的患者进行了研究。诱发了13例间隔性VT，定义为右心室和左心室心内膜突破均位于间隔面的VT。根据右心室和左心室间隔心内膜突破的部位和时间确定VT的起源部位。根据心外膜突破部位，将所有VT分为三组：A型，心外膜在室间前区突破；F型，心外膜在右心室游离壁突破；P型，心外膜在室间后区突破。所有F型VT均在前间隔有右心室心内膜突破，且早于左心室心内膜突破，提示起源于右前间隔。在A型和P型中，右心室和左心室心内膜突破均位于间隔的同一侧（分别为前侧和后侧），但其相对时间不一致。该结果表明，心外膜标测，甚至像体表标测这样的非侵入性方法，都可以识别间隔性VT的起源部位，尤其是当心外膜突破发生在右心室游离壁时。
