Kałka D, Jagielski J, Banasiak W, Sobieszczańska M A, Telichowski A, Fuglewicz A, Pieróg M, Ponikowski P, Jagielski D, Kałka-Gebala R, Gajkowski E
Katedra i Zakład Patofizjologii Akademii Medycznej we Wrocławiu.
Pol Arch Med Wewn. 1996 Sep;96(3):234-41.
Research on body surface potential mapping concerned predominantly the ventricular excitation process. There is only very limited data available documenting surface potential distribution during atrial electric events. The goal of this study was to establish the pattern and criteria of the atrial potential maps in the healthy population, which is substantial for a prospective usefulness of the noninvasive registrations of surface maps in atrial arrhythmias. A group of 54 subjects in whom there was no clinical evidence of cardiac dysfunction underwent a procedure of body surface potential mapping. The recordings were performed using the HPM-7100 system simultaneously from 87 leads covering the entire thorax. Isopotential maps registered during the P wave were subjected to the statistical analysis by means of the own system "Heart Map" enabling the qualitative and quantitative estimation of the atrial maps. To avoid a problem of variable heart rate, a time standardization, by the division of the P wave into 10 time intervals, was applied. In order to eliminate an interindividual variability of heart location in the thorax, a distribution of the constituent values without subordinating them to the individual electrodes was proposed. In consequence, the group-mean isopotential maps of the wave P for the normal subjects were created. According to the migration of the maximum throughout the thoracic surface during the P wave, three phases of the isopotential atrial maps were determined: phase 1 (P1-P4) comprising initial 40% of the P wave, phase 2 (P5,P6)-next 20% of the P wave and phase 3 (P7-P10)-the terminal 40% of the P wave duration. These phases reflect the successive sequences of atrial excitation. During the whole atrial depolarization the minimum of potential, changing its value, was located around lead D7. Furthermore, in the results of the analysis of the constituent values sequences, for the P wave time intervals the additional quantitive parameters were calculated, i.e. areas designated by positive and negative potential and the ratio of these areas. The presented findings revealed that surface maps give the precious insight into spread of atrial excitation. Establishing of the distribution pattern and the criteria of the atrial potential maps for normals enables to undertake the further research on the use of this technique in a various atrial pathology.
体表电位标测的研究主要关注心室兴奋过程。目前仅有非常有限的数据记录心房电活动期间的体表电位分布。本研究的目的是建立健康人群心房电位图的模式和标准，这对于心房心律失常体表图无创记录的前瞻性应用具有重要意义。一组54名无心脏功能障碍临床证据的受试者接受了体表电位标测检查。使用HPM - 7100系统同时从覆盖整个胸部的87个导联进行记录。在P波期间记录的等电位图通过自身的“心脏图”系统进行统计分析，该系统能够对心房图进行定性和定量评估。为避免心率变化问题，采用将P波分为10个时间间隔的时间标准化方法。为消除个体心脏在胸腔中位置的个体间变异性，提出了不将组成值从属于单个电极的分布方式。结果，创建了正常受试者P波的组均值等电位图。根据P波期间最大值在整个胸壁表面的移动，确定了等电位心房图的三个阶段：阶段1（P1 - P4）包括P波最初的40%，阶段2（P5，P6） - P波接下来的20%，阶段3（P7 - P10） - P波持续时间的最后40%。这些阶段反映了心房兴奋的连续顺序。在整个心房去极化过程中，电位最小值及其变化值位于D7导联附近。此外，在组成值序列分析结果中，针对P波时间间隔计算了额外的定量参数，即正电位和负电位指定的面积以及这些面积的比值。所呈现的研究结果表明，体表图能深入了解心房兴奋的传播。建立正常人心房电位图的分布模式和标准有助于进一步研究该技术在各种心房病变中的应用。
