Goyal R, Harvey M, Daoud E G, Brinkman K, Knight B P, Bahu M, Weiss R, Bogun F, Man K C, Strickberger S A, Morady F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
Circulation. 1996 Dec 1;94(11):2843-9. doi: 10.1161/01.cir.94.11.2843.
Ventricular pace mapping is performed by comparing the QRS morphology of ventricular paced complexes to that of a template arrhythmia, either a premature ventricular depolarization or a QRS complex during ventricular tachycardia. The objective of this study was to evaluate the effect of coupling interval and pacing cycle length on QRS morphology.
The study population consisted of 20 patients (mean age, 38 +/- 16 years) undergoing a clinically indicated electrophysiology procedure. In the first 10 patients, the effect of coupling interval on the morphology of single paced ventricular complexes was evaluated visually and by signal processing techniques. Visually apparent differences in QRS morphology occurred in a mean of 4/12 electrocardiographic leads with a change in coupling interval of > or = 100 ms. In the next 10 patients, the QRS complex morphology during ventricular overdrive pacing at cycle lengths of 600 and 300 ms was found to differ significantly in a mean of 4/12 leads. The QRS morphology during overdrive pacing differed significantly from that of a single paced complex whenever the pacing cycle length differed from the coupling interval of the single paced complex by > 80 ms.
The morphology of single paced QRS complexes may vary, depending on coupling interval, and the QRS morphology during overdrive pacing is affected by the pacing cycle length. During ventricular pace mapping, the coupling interval or cycle length of the template arrhythmia should be matched during pacing. If not, rate-dependent changes in QRS morphology that are independent of the pacing site may confound the results of pace mapping.
心室起搏标测是通过将心室起搏复合波的QRS形态与模板心律失常（室性早搏或室性心动过速时的QRS复合波）的QRS形态进行比较来完成的。本研究的目的是评估耦联间期和起搏周期长度对QRS形态的影响。
研究人群包括20例（平均年龄38±16岁）接受临床指征的电生理检查的患者。在前10例患者中，通过视觉和信号处理技术评估耦联间期对单个起搏心室复合波形态的影响。当耦联间期改变≥100 ms时，平均4/12个心电图导联出现QRS形态的明显视觉差异。在接下来的10例患者中，发现在600和300 ms周期长度的心室超速起搏期间，平均4/12个导联的QRS复合波形态有显著差异。只要起搏周期长度与单个起搏复合波的耦联间期相差>80 ms，超速起搏期间的QRS形态就与单个起搏复合波的形态有显著差异。
单个起搏QRS复合波的形态可能因耦联间期而异，超速起搏期间的QRS形态受起搏周期长度影响。在心室起搏标测期间，起搏时应匹配模板心律失常的耦联间期或周期长度。否则，与起搏部位无关的QRS形态的频率依赖性变化可能会混淆起搏标测的结果。
