Inaba-Sato F, Hirai M, Hayashi H, Yoshida Y, Yanagawa T, Tomita Y, Iwata K, Abe K, Terazawa M, Akahoshi M, Sugino M, Saito H
First Department of Internal Medicine, University of Nagoya School of Medicine, Japan.
J Electrocardiol. 1996 Oct;29(4):301-8. doi: 10.1016/s0022-0736(96)80094-x.
Marked T wave abnormalities in 12-lead electrocardiograms often appear after radiofrequency ablation in patients with Wolff-Parkinson-White (WPW) syndrome. Durations of the QRS complex before ablation have been reported to be significantly greater in patients with repolarization abnormalities after ablation than in those with normal repolarization. However, there has been no report concerning the relationship between QRS duration and repolarization abnormalities before ablation. It has been reported that QRST isointegral maps are dependent on local cellular repolarization properties but largely independent of activation sequence, and that they provide quantitative information about repolarization abnormalities. Isointegral maps were constructed from data recorded in 34 patients with WPW syndrome and QRS durations of 0.1 second or longer (21 patients with left-sided accessory pathways and 13 with right-sided pathways) in order to investigate the relationship between QRS duration and abnormalities in repolarization properties during preexcitation. Body surface ECGs were recorded with an 87-lead system at a sampling interval of 1 ms. The QRST values (mean +/- 2SD) from 607 normal individuals were taken to represent the normal range. The area with abnormally low QRST values was designated as the -2SD area and the sum of the QRST values (sigma QRST) in this area was calculated. The QRS duration was found to be significantly related to sigma QRST. These results demonstrate that the patients with WPW syndrome had abnormalities in local repolarization properties that were significantly related to QRS duration during preexcitation. The degree of preexcitation may be important in producing these abnormalities in patients with manifest WPW syndrome. This may result in T wave abnormalities after ablation of the accessory pathway attributable to cardiac memory.
预激综合征（WPW）患者接受射频消融术后，12导联心电图常出现明显的T波异常。据报道，消融术后出现复极异常的患者，消融前QRS波群时限显著长于复极正常的患者。然而，关于消融前QRS时限与复极异常之间的关系尚无报道。据报道，QRST等积分图依赖于局部细胞复极特性，但在很大程度上独立于激动顺序，并且它们提供有关复极异常的定量信息。为了研究预激期间QRS时限与复极特性异常之间的关系，我们从34例WPW综合征且QRS时限为0.1秒或更长的患者（21例左侧旁路患者和13例右侧旁路患者）记录的数据构建等积分图。使用87导联系统以1毫秒的采样间隔记录体表心电图。取607名正常个体的QRST值（平均值±2SD）代表正常范围。将QRST值异常低的区域指定为-2SD区域，并计算该区域内QRST值的总和（σQRST）。发现QRS时限与σQRST显著相关。这些结果表明，WPW综合征患者存在局部复极特性异常，这些异常与预激期间的QRS时限显著相关。在显性WPW综合征患者中，预激程度可能对产生这些异常很重要。这可能导致旁路消融后由于心脏记忆而出现T波异常。
