江西医药
江西醫藥
강서의약
JIANGXI MEDICAL JOURNAL
2014年
1期
1-3
,共3页
张繁之%盛国太%曹乾嫱%黄清
張繁之%盛國太%曹乾嬙%黃清
장번지%성국태%조건장%황청
心肌复极%心力衰竭%心脏再同步化治疗
心肌複極%心力衰竭%心髒再同步化治療
심기복겁%심력쇠갈%심장재동보화치료
Ventricular repolarization%Heart failure%Cardiac resynchronization therapy
目的：观察正常心脏不同部位起搏时心室肌复极的变化。方法按文献方法制备带冠状动脉分支的犬左心室楔形心肌块模型，记录心内膜下心肌、中层心肌和心外膜下心肌的跨膜动作电位，同时记录心肌块的整体电活动(容积心电图)。分析不同部位起搏时T波峰末（Tp-e）间期。临床上10例接受射频消融术后的患者，经冠状静脉窦将1根标测电极送至左心室表面静脉分支，另1根电极送达右室心尖部，分别起搏左心室心外膜、右心室心内膜及上述两部位同时起搏，记录心电图并测量Tp-e间期。结果反映心肌跨室壁复极离散的心电图指标Tp-e间期在心外膜刺激( Epi)时最大：（86.56±16.34）ms，其次为内外膜同时刺激(Bi)：（76.68±14.89）ms，最小为心内膜刺激(Endo)：（55.21±13.86）ms(两两比较，均P<0.01)。而在人体，体表心电图上Tp-e间期在左室心外膜起搏(LV-Epi)（106.48±18.37）ms、双心室起搏(BiV)（99.58±22.53）ms明显较右心室心内膜起搏(RV-Endo)（95.48±13.65）ms延长(P<0.05)。结论左室心外膜参与起搏后会增大心室肌的跨室壁复极差异，可能在心脏再同步化治疗心衰中具有致心律失常性。
目的：觀察正常心髒不同部位起搏時心室肌複極的變化。方法按文獻方法製備帶冠狀動脈分支的犬左心室楔形心肌塊模型，記錄心內膜下心肌、中層心肌和心外膜下心肌的跨膜動作電位，同時記錄心肌塊的整體電活動(容積心電圖)。分析不同部位起搏時T波峰末（Tp-e）間期。臨床上10例接受射頻消融術後的患者，經冠狀靜脈竇將1根標測電極送至左心室錶麵靜脈分支，另1根電極送達右室心尖部，分彆起搏左心室心外膜、右心室心內膜及上述兩部位同時起搏，記錄心電圖併測量Tp-e間期。結果反映心肌跨室壁複極離散的心電圖指標Tp-e間期在心外膜刺激( Epi)時最大：（86.56±16.34）ms，其次為內外膜同時刺激(Bi)：（76.68±14.89）ms，最小為心內膜刺激(Endo)：（55.21±13.86）ms(兩兩比較，均P<0.01)。而在人體，體錶心電圖上Tp-e間期在左室心外膜起搏(LV-Epi)（106.48±18.37）ms、雙心室起搏(BiV)（99.58±22.53）ms明顯較右心室心內膜起搏(RV-Endo)（95.48±13.65）ms延長(P<0.05)。結論左室心外膜參與起搏後會增大心室肌的跨室壁複極差異，可能在心髒再同步化治療心衰中具有緻心律失常性。
목적：관찰정상심장불동부위기박시심실기복겁적변화。방법안문헌방법제비대관상동맥분지적견좌심실설형심기괴모형，기록심내막하심기、중층심기화심외막하심기적과막동작전위，동시기록심기괴적정체전활동(용적심전도)。분석불동부위기박시T파봉말（Tp-e）간기。림상상10례접수사빈소융술후적환자，경관상정맥두장1근표측전겁송지좌심실표면정맥분지，령1근전겁송체우실심첨부，분별기박좌심실심외막、우심실심내막급상술량부위동시기박，기록심전도병측량Tp-e간기。결과반영심기과실벽복겁리산적심전도지표Tp-e간기재심외막자격( Epi)시최대：（86.56±16.34）ms，기차위내외막동시자격(Bi)：（76.68±14.89）ms，최소위심내막자격(Endo)：（55.21±13.86）ms(량량비교，균P<0.01)。이재인체，체표심전도상Tp-e간기재좌실심외막기박(LV-Epi)（106.48±18.37）ms、쌍심실기박(BiV)（99.58±22.53）ms명현교우심실심내막기박(RV-Endo)（95.48±13.65）ms연장(P<0.05)。결론좌실심외막삼여기박후회증대심실기적과실벽복겁차이，가능재심장재동보화치료심쇠중구유치심률실상성。
Objective To investigate the changes of ventricular repolarization when pacing at different sites of normal heart. Methods According to literature in previous publications,The tissue was cannulated via a native branch of left descending coro-nary artery and perfused with Tyrodes’solution,Transmembrane action potentials from sub-epicardial,mid-myocardial,and sub-endocardial sites were simultaneously recorded by using floating glass microelectrodes. A transmural ECG calculated by subtract-ing the transmural activities from sub-epicardium through the sub-endocardium was recorded concurrently. Twave peak to end in-terval (Tp-e),which representing myocardial repolarization transmural dispersion was measured and compared between different pacing strategies. In clinic,ten patients without structural heart diseases were examined after they were successfully performed RF-CA for SVT. Two electrodes were located at right ventricular apex endocardium(RV-Endo) and left ventricular epicardium(LV-Epi) retrograde through coronary sinus respectively. 12-lead ECG was recorded synchronously during programmed stimuli at different sites. Results The Tp-e interval was(86.56±16.34)ms (Epi),(76.68±14.89)ms (Bi),and(55.21±13.86)ms (Endo)respectively (all P<0.01),indicating that simultaneous pacing from Bi and Epi increased the transmural dispersion of myocardial repolarization. In clinic,Tp-e interval when pacing at LV-Epi (106.48±18.37)ms and BiV (99.58±22.53)ms were much longer than that when pac-ing at RV-Endo (95.48±13.65)ms (P<0.05). Conclusion LV-Epi pacing might result in enlargement of transmural dispersion of myocardial repolarization shown as the changes of Tp-e intervals,which may be proarrhythmic in cardiac resynchronization therapy in congestive heart failure patients.
