Jung J, Hohenberg G, Heisel A, Strauss D, Schieffer H, Fries R
Medizinische Universitätsklinik, Innere Medizin III, Homburg/Saar, Germany.
J Cardiovasc Electrophysiol. 1998 Jul;9(7):689-95. doi: 10.1111/j.1540-8167.1998.tb00955.x.
Analysis of endocardial signals obtained from an electrode located in the right atrium as realized in newly designed dual chamber, implantable cardioverter defibrillators might be used to provide additional therapeutic options, such as overdrive pacing or low-energy atrial cardioversion for the treatment of concomitant atrial flutter (AFL) or atrial fibrillation (AF). Therefore, we developed a computer algorithm for discrimination of normal sinus rhythm (NSR), AFL, and AF that may lead to adequate differential therapy of atrial tachyarrhythmias in an automated mode.
During an electrophysiologic study, bipolar endocardial signals from the high right atrium were obtained in 28 patients during sustained AFL or AF and after restoration of NSR. A total of 286 data segments of 5-second duration were recorded (NSR: 96, AFL: 86, AF: 104). Mean atrial cycle length (MCL), standard deviation of mean atrial cycle length (SDCL), and index of irregularity (IR), defined as the ratio between MCL and SDCL, were calculated for each data segment. A cutoff of 315 msec for MCL allowed discrimination of NSR from atrial tachyarrhythmias with 100% sensitivity and specificity. For discrimination of AF from AFL by using SDCL, a cutoff value of 11.5 msec led to a sensitivity of 99% and a specificity of 90%. Best discrimination of AF from AFL was found for the criterion IR > or = 7.5%, resulting in a sensitivity of 100% with a specificity of 95% for AF detection.
The investigated algorithm provides discrimination of NSR, AFL, and AF with high sensitivity and specificity. Incorporation of this algorithm in an implantable automated antitachycardia device may lead to adequate differential therapy in patients suffering from spontaneous episodes of AF and AFL.
在新设计的双腔植入式心脏复律除颤器中，对位于右心房的电极所获取的心内膜信号进行分析，可用于提供额外的治疗选择，如超速起搏或低能量心房复律，以治疗合并的心房扑动（AFL）或心房颤动（AF）。因此，我们开发了一种计算机算法，用于鉴别正常窦性心律（NSR）、AFL和AF，该算法可能会以自动化模式实现对房性快速心律失常的适当差异治疗。
在一项电生理研究中，在28例患者持续AFL或AF期间以及恢复NSR后，获取了来自高位右心房的双极心内膜信号。共记录了286个持续5秒的数据段（NSR：96个，AFL：86个，AF：104个）。计算每个数据段的平均心房周期长度（MCL）、平均心房周期长度的标准差（SDCL）以及不规则指数（IR），IR定义为MCL与SDCL之比。MCL的截断值为315毫秒时，可100%的灵敏度和特异性鉴别NSR与房性快速心律失常。通过使用SDCL鉴别AF与AFL时，截断值为11.5毫秒时，灵敏度为99%，特异性为90%。对于IR≥7.5%的标准，AF与AFL的鉴别效果最佳，AF检测的灵敏度为100%，特异性为95%。
所研究的算法能以高灵敏度和特异性鉴别NSR、AFL和AF。将该算法纳入植入式自动抗心动过速装置中，可能会为患有AF和AFL自发发作的患者带来适当的差异治疗。
