右ブンドル・ブランク・ブロック・ヴァントリキュラー・タヒカルディア:セプトと横心室の起源は,右心室の頂点への活性化時間に基づいています
Vickas V Patel1, Robert W Rho, Edward P Gerstenfeld
1Section of Cardiac Electrophysiology, University of Pennsylvania Health System, Philadelphia, Pa, USA.
Circulation
|October 20, 2004
まとめ
静脈動脈不全 (VT) の起源を区別することは困難です. この研究では,QRS-RVA時間は,特にアピカル心臓発作後の,セプトと横軸の起源を効果的に区別することを示しています.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- メディカルイマージング (医学イメージング)
背景:
- 右束枝ブロック (RBBB) 型のパターンで,リードV1でR-S比率>1で心室性短拍 (VT) の起源を特定することは,標準の12リードECGを使用すると困難です.
- 以前の頭蓋骨梗塞は,左心室の横壁対隔膜から発生するVTのECGベースの局所化をさらに複雑にします.
研究 の 目的:
- 右心室頂部活性化 (QRS-RVA) 時間までのQRS複合体の発現の有用性を評価し,セプトと横心室動脈低心率 (VT) の起源を区別する.
- この方法の有効性を評価するために,以前の頭梗塞とそれなしの患者で.
主な方法:
- 58人の静脈筋梗塞の患者の見通し評価,アピカル心臓発作,ノンアピカル心臓発作,または心臓病がないグループに分類.
- 左心室 (LV) のアピカルセプトと横行ペースの間に,右心室頂点 (stim-RVA) でのQRS複合体の発症から活性化までの測定.
- 47のRBBB型VTsの位置付けは,エントレインメント技術を使用してセプトまたは横軸の頂点まで,そして電気解剖学的マッピングによって確認.
主要な成果:
- すべての患者グループにおいて,セプタルとラテラルペース/VTサイト間で,スチム-RVAとQRS-RVA時間の有意な差異が観察されました.
- アピカル心臓発作の患者では,スティム-RVAは59 ms (septal) 対187 ms (lateral) であり,QRS-RVAは50 ms (septal) 対178 ms (lateral) であった (P<0.001).
- 同様の有意な差異は,非アピカル心筋梗塞と心臓病のない患者の間で発見され,地域特異性を確認しました.
結論:
- QRS-RVA時間は,左心室隔膜から発生するVTと,横の頂点から発生するVTの間で大きく異なる.
- これらの発見は,V1 R-S比率>1.1のRBBB型VTにおけるVT起源を迅速に地域化するための貴重なツールを提供します.
- この方法は,従来のEKGの差異化が信頼性が低いアピカル梗塞の患者に特に有用です.
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