136例体表希氏束电图分析

应用体表电信号叠加平均方法检测希氏束电图136例,其中102例正常人做为对照组,心脏病患者共34例,其中有6例为可疑病窦,同时进行腔内导管法检测。结果显示各类心血管疾病组所测结果符合临床诊断;正常对照组所测各间期数值与腔内导管法所测之数值极为接近,故体表希氏束电图法可做为检测心律失常辅助诊断的一项有价值的方法。     

体表希氏束电图检测新方法

希氏束电图(HBE)是描记心内传导系统电位变化的曲线,其电信号极其微弱,只有1～10μV左右,通常的放大方法无法记录到。我们采用数字滤波加模式识别的新方法,联合研制出TZXJ-1型体表逐搏希氏束检测仪,对7只杂种犬进行了动物实验,取得了满意的图形。现将研究结果报告如下:1.逐搏体表希氏束检测仪是一个在微机下根据USB接口的三导联测量系统来进行体表希氏束电位的逐拍检测,由硬件和软件两部分组成。(1)硬件。系统中有,一路心电放大器和两路希氏束(心内和体表)放大器。放大器总增益均为2000,滤波范围为0.1～200Hz。均采用差动放大电路,由于…     

利多卡因对有或无窦房功能不全患者的窦房结和心房的电生理学作用

某些病人在用利多卡因静脉注射时或注射后发生窦性停搏。作者应用刺激心房的方法,评价利多卡因对于伴有或没有窦房结功能不全患者的窦房结和心房的电生理作用。方法:27例患者,其中13例窦房结功能正常,14例有窦房结功能不全。患者均为窦性心律,至少72小时内未用过心脏药物。以一根三极导管经股静脉插入记录希氏束电图。一根四极导管置于右房上方靠近窦房结处供心房调搏(远端两极)和记录右房上方心电图(近端两极);同时作体表心电图记录(导     

健康狗希氏束电图的描测与分析

在心血管电生理及药理学研究中常以狗为实验对象,体表心电图的变化虽是常用指标,但它测不出房室结和希氏束浦顷野系统的电活动。近年来发展较快的希氏束电图则弥补了这一不足。国内外对正常狗希氏束电图的记录曾有报道,但迄今为止,对于较大系列健康狗希氏束电图正常时值的研究,尚未见论述。现将正常成年杂交狗希氏束电图报道如下。     

体表希氏束电图的临床应用研究

自1996年以来,我们采用MCDA-1041型多功能心脏诊断仪(国产),观察了15例传导阻滞患者体表希氏束电图的改变,现将结果报告如下。1　对象与方法1.1　对象选择我院住院传导阻滞病例15例,内有°房室传导组滞者10例(合并完全左束支组滞1例);完全右束支阻滞3例,°房室传导阻滞者2例。1.2　方法仪器:MCDA-1041型多功能心脏诊断仪(国产)。采用高通滤波的频带为40～250Hz,记录256～300次心动周期,进行叠加,控制噪音水平在0.1μV,叠加后的体表希氏束电图储存在计算机中,记录体表希氏束电图同时描记心电图作对照分析,描记速度200mm/sec,最后用手控制…     

信号叠加方法记录体表希氏束电图的初步探讨

本文应用信号叠加方法对13例先心病患者(其中12例心电图上无传导异常表现,1例为Ⅰ度房室传导阻滞)进行了体表希氏束电图的测定、采用X、Y、Z正交双极导联,叠加300～400次心动周期,滤波频率为40～250Hz。测定结果与心内希氏柬电图进行了时比研究,取得了良好的相关性,各间期相关系数为0.70～0.92。时Ⅰ度房室传导阻滞患者,体表希氏束电图可为其提供定位诊断。从而证实信号叠加方法记录体表希氏来电图的可行性,准确性及临床应用价值     

房室传导阻滞的室房逆行传导

对30例经希氏束电图证实的不同程度及不同阻滞水平的房室传导阻滞患者的室房逆行传导进行研究,其方法为用右室连续递增起搏和S_1S_2程序刺激两种方式判定室房逆传功能,同步记录体表心电图和希氏束及高位右房电图.确定室房逆传方法为(1)有效心室起搏V波后有相应的A波,由希氏束及高右     

射频消融治疗室上性心动过速的操作要点

<正> 一、房室结改良1.标测(1)快径(FP)消融:首先用大头导管记录清楚的希氏束电图,然后将导管顶端慢慢向心房侧后撤,直至显示大房(A)波、小室(V)波,希氏束电图刚消失或极小,振幅<50μV,即为 FP 的消融部位。(2)慢径(SP)消融:有三种标测方法:①下位法。首先用大头导管记录希氏束电图,然后将导管顶端下垂,显示小 A 波,大 V 波(A/V<0.40),其间记录不到希氏束电图处,为消融部位。②中间隔法。在左或右前斜位30°时,将大头导管放置在希氏束导管顶端与冠状窦口连线中点消融。③后位     

希氏束电图的记录与希氏束起搏

<正>希氏束电图的导管记录技术的问世奠定了临床心脏电生理学成为心脏病学一门新的亚学科的基础,本文将回顾希氏束电图记录技术的发展,以及在该技术的基础上,直到最近出现的希氏束起搏用于心脏再同步化治疗(cardiac resynchronization therapy,CRT)的进展。这些新技术基于良好的实验室和临床研究基础,因应用导管技术实现永久性希氏束起搏是可行的。快速涌现的大量证据已显示永久性希氏束起搏不仅是CRT(双室起     

完全性希氏束内阻滞

报告经希氏束电图证实的9例完全性希氏束内阻滞。全部患者均可见分裂的希氏束电位。并对该心律失常的希氏束电图和体表心电图表现,以及注射阿托品后的心室率改变等进行讨论。     

Non-invasive recording of the His bundle electrogram: choice of leads and reliability of the "averaging" technic

An improvement in detecting His bundle activity using a Marquette high resolution Mac unit, without pharmacologic depression of AV node conduction, was obtained with two surface lead systems, which were selected on the basis of the His bundle anatomical position and its electrostimulation axis. In 8 patients the direction of the His bundle bipolar stimulation vector was evaluated in the frontal plane, on the orthogonal leads and with map of the chest potential. In 39 patients the surface recording, using high-gain amplification, filtering between 50-300 Hz and an averaging of 256-512 cycles, was obtained by positioning the electrodes in the following sites: manubrium sterni-xiphisternum-V4. When this lead system failed, it was replaced by another one, which included V4-right sternal and right vertebral border at the level of the 3rd intercostal space. In 24 patients (PR less than 0.16" in 4 cases) intracavitary and surface H-V recording were compared. The surface interval was measured between the apex of the surface "blip" and onset of the QRS. Sensitivity was 86% with a good correlation (r = 0.94) between invasive and non-invasive measurements. The surface leads, in which the His bundle activity was best detected, were the manubrium-xiphisternum (on the midsternal line) and V4-right vertebral border at the 3rd intercostal space level. Our external measurement technique avoids subjective misinterpretations; the surface H-V interval was on an average 6 msec. shorter than the invasive one. The upper normal value of non-invasive H-V interval is therefore 50 msec in our measurement method.     

Noninvasive recording of His bundle activity with an analog delay device in normal subjects and patients with atrioventricular block

Summary A simplified and clinically applicable method has been developed for real-time noninvasive recording of the electrical activity of the His bundle in the human heart. A surface electrocardiogram (ECG) was obtained from bipolar precordial leads. The electrical signal within the P-QRS segment of the ECG was amplified with a high gain amplifier and delayed with an analog delay device for QRS-triggered signal averaging. The analog delay device consisted of a bucket brigade device (BBD) with an electrical integrated circuit (IC). After filtering with a band width of 50–300Hz, the delayed signal was processed by a microcomputer system and the signal-to-noise ratio of the signal was improved by the signal averaging technique.Surface His bundle electrocardiograms (SHE) were measured in normal subjects without conduction disorders and in patients with atrio-ventricular (A–V) block. In the same patients, each SHE was nonsimultaneously compared with an invasive His bundle electrogram (HBE) obtained by the intracardiac catheter technique. The results of this comparison confirmed that the noninvasive method of SHE recording has broad clinical applicability and high utility for the screening of patients with latent A–V block before intracardiac catheterization is performed.     

Analysis of PR subintervals in normal subjects and early studies in patients with abnormalities of the conduction system using surface His bundle recordings

Utilizing several different approaches to noise reduction, satisfactory beat by beat His bundle activity was recorded from the chest surface in 41 (80%) of 52 normal subjects. Surface atrial to His intervals (PAH) and His to ventricular intervals (HV) were measured in this group and compared with subintervals of the PR segment recorded endocardially from 47 persons with normal electrophysiologic findings. A recent modification in the selection algorithm allows on-line identification of the four of five possible recording sites for utilization in a spatial summation. The ability to record in less favorable circumstances has been improved to the extent that records of suitable clarity for measurement were also obtained in 17 (77%) of 22 individuals with conduction system abnormalities. Comparison of the surface and endocardially acquired data in the normal group reveals no statistically significant difference in the surface acquired PAH and endocardially acquired high right atrial to His (HRAH) intervals, nor in the HV intervals. In a small subset of patients data were acquired by both techniques and no significant differences were found. Thus, when programmed stimulation or endocardial mapping is not required to answer specific clinical questions, in the majority of persons it is possible to record meaningful subintervals from the body surface from each cardiac cycle. Additionally, in instances in which surface P wave activity is obscure in the routine electrocardiogram, this technique enhances atrial electrical activity.     

Surface recording of electrical activity from the region of the bundle of His

In 16 dogs, by appropriate filtering and digital averaging on a PDP-9 computer, we were able to enhance the detection of electrical activity of interest in the P-R segment of the electrocardiogram. In instances (1) when such activity in the surface record coincided temporally with the internal recording from the bundle of His area, (2) when, with atrioventricular nodal block, the electrical activity of interest continued to be associated with the internally recorded His bundle deflection and not with atrial activity, and (3) when, with production of transmission delay between the bundle of His and the ventricle, the surface signal of interest continued to be associated with the internal His bundle deflection, a common signal source was considered likely. In certain instances the surface signal of interest in the P-R segment occurred well after the internally recorded His bundle deflection but about 15 msec before the earliest evidence of ventricular activity. In these instances, when the tests cited were applied and the blip of interest was associated with ventricular activity, the origin of the blip was thought to be in the region of the bundle branches.In the 16 animals studied, one or more pieces of the evidence described were present to localize the origin of the signal. In seven animals, the signal was thought to originate from the bundle of His, in six from the region of the bundle branches and in three from both the bundle of His and bundle branches.     

The junctional premature beat: an instructional exercise in modes of concealment.

?The relative brevity of the main His bundle refractory period compared with that of the A-V node above, and the trifascicular system below, makes it likely that premature beats originating in the His bundle will encounter physiologic delay, or block in both antegrade and retrograde modes. Two clinical cases of junctional premature beats are presented, which demonstrate many facets of concealment (antegrade, retrograde and bidirectional). Hitherto unreported is a ventricular echo which was induced by a junctional premature beat, the antegrade concealment of which was due to functional trifascicular block.     

Noninvasive His bundle electrogram: Value of three vector lead recordings

Studies were conducted in 45 patients to determine whether the reliability of the measurement of the His bundle potential from the body surface was increased by signal averaging of three simultaneously recorded electrocardiographic potentials from horizontal (X), frontal (Y) and sagittal (Z) axes as opposed to recording of any of these. Potentials from the X, Y and Z leads were amplified by 250,000, filtered between 80 hertz (12 dB/octave) and 200 hertz (24 dB/octave) and signal averaging of 1,000 beats was performed. The His bundle potential could be clearly defined in 25 of the 45 patients in the X, Y or Z lead. His bundle potentials were evident in the X lead in 17 (68 percent) of these 25 patients, in the Y lead in 19 (77 percent) and in the Z lead in 11 (44 percent). No single lead gave satisfactory His bundle electrographic potentials in all patients. In 20 patients the His bundle electrogram could not be recorded because terminal atrial activity overlapped activity of the His bundle potential. The three lead system defined the His bundle potential in a significantly greater number of patients than did the best single lead because it (1) displayed the vectorial lead with the largest His bundle potential, (2) permitted validation of the His bundle potential in more than one lead, and (3) displayed the vectorial lead with the most isoelectric terminal P wave. It is concluded that reliable His bundle potential measurements are obtained in a significantly greater number of patients with use of the simultaneous three lead system than with use of any single lead.     

早搏揭示位相型束支阻滞的心电图分析

目的探讨早搏对位相型束支阻滞的揭示作用和诊断价值。方法利用早搏的回归周期明显长于基础周期这一特征,对17例患者早搏后第1次窦性搏动形态改变进行分析,间接诊断位相型束支阻滞,并确定其类型。结果 17例患者早搏后的QRS形态均发生改变,依据位相型束支阻滞诊断标准,共发现3相右束支阻滞8例、3相左束支阻滞5例、3相左前分支阻滞1例、4相右束支阻滞1例、4相左束支阻滞2例。结论位相型束支阻滞多呈一过性改变,较难扑捉,借助于早搏后回转周期长于基础窦性周期来间接诊断是一种简洁、可靠的方法,无疑对基础疾病的预后判断以及对心律失常机制的理解是十分有益的。     

His束记录部位非常靠近冠状窦口的房室结折返性心动过速的消融治疗

探讨His束记录部位非常靠近冠状窦口时的房室结折返性心动过速 (AVNRT)的射频消融方法及有效性。对7例His束记录部位非常靠近冠状窦口的AVNRT的患者进行射频消融 ,男 5例、女 2例 ,年龄 6 5 .3± 3.5 (6 0～ 75 )岁。常规放置电极导管至高位右房、His束和冠状窦 ,发现 4例记录到最大His束电位的部位与冠状窦口位于同一水平线 ,3例在其下方 2～ 4mm。采用左前斜位 (LAO) 4 5°和右前斜位 30°,尤其是LAO 4 5°在最大His束电位记录部位下方 ,细标靶点 ,当A波碎裂 ,或记录到慢径电位 ,而无His束电位时试放电消融。 6例成功 ,其中 4例在LAO相当于 6点处消融成功 ,2例在 6点半左右处成功 ,1例应用了Swartz鞘。平均手术时间 1.5± 0 .3h。随访 1～ 2年 ,6例成功患者未见复发。结论 :对His束最大记录部位非常靠近冠状窦口的患者 ,主要在LAO 4 5°冠状窦口下方细标靶点 ,可提高慢径消融的成功率并节省时间     

Paraseptal accessory connections in the proximity of the atrioventricular node and the His bundle. Additional observations in relation to the ablation technique in a high risk area.

INTRODUCTION: Paraseptal pathways, namely, accessory connections (AC) in the vicinity of the atrioventricular node (AVN) and the bundle of His, are associated with a high risk of complete atrioventricular block (AVB) during transcatheter radiofrequency ablation (RFA) in the Electrophysiology Laboratory. In previously reported series of ablation of paraseptal ACs, the coexistence of multiple ACs in this high-risk region has rarely been mentioned. METHODS AND RESULTS: We studied 15 patients undergoing RFA of paraseptal ACs 2 of whom had dual pathways with an additional midseptal pathway revealed after the elimination of the anteroseptal target AC. The fundamental goal of the pre-ablation electrophysiological mapping was the clear-cut determination of anatomical site with His bundle recording activity. This required unique pharmacological and programmed electrical stimulation manipulations in 8 patients in whom His bundle recording activity was only temporarily possible. After identifying the corresponding His bundle site, special attention was given to the ablation catheter being situated at least 3 mm away, thus recording minimal or no His bundle activity. Additional precautions were taken so that the delivered therapy was of minimal duration and powered by temperature regulation with immediate interruption in case of AVB or nodal rhythm appearance. With this therapeutic approach, 16 of the 17 paraseptal ACs were ablated successfully with the inadvertent induction of AVB in only 1 patient. In the patient with persistent ventricular preexcitation after the ablation session, modification of both the AC and the AVN was noted so that the previously easily induced reciprocating atrioventricular tachycardia was no longer so, using programmed stimulation. CONCLUSION: Transcatheter radiofrequency ablation is a feasible and effective radical therapy for patients with paraseptal ACs, provided the His bundle site has first been clearly defined and the coexistence of other nearby tracts has been excluded.     

Recording the bundle of His potential using an esophageal electrode

A noninvasive method for recording His bundle potential is reported that includes amplification of ECG in bipolar esophagosternal leads. A total of 106 patients were examined, with the His potential recorded in 78 (73.6%) of those. The method was validated by simultaneously recorded intracardiac electrograms in 6 patients and by atrial pacing in 3 patients. The advantages and limitations of this method are discussed.