中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2014年
6期
430-434
,共5页
曹园园%汪菁峰%宿燕岗%葛均波
曹園園%汪菁峰%宿燕崗%葛均波
조완완%왕정봉%숙연강%갈균파
心脏再同步治疗%起搏心电图%心电轴
心髒再同步治療%起搏心電圖%心電軸
심장재동보치료%기박심전도%심전축
Cardiac resynchronization therapy%Pacing electrocardiogram%Cardiac electric axis
目的 分析行心脏再同步治疗(CRT)的患者在不同起搏模式下的心电图QRS波电轴的分布特点,以及与左心室导线位置、左心室逆重构的关系.比较12导联同步心电图机自动分析与手动测量的心电轴的差异.方法 入选2012年11月到2013年6月在上海复旦大学附属中山医院行CRT植入的41例患者,分别记录患者术后3个月在单纯左心室起搏,左心室提前60ms、40ms、20ms、0ms,右心室提前20ms、40ms,单纯右心室起搏的12导联同步心电图共326份,记录12导联同步心电图机自动分析得出的心电轴,同时手动测量I和aVF导联QRS波的净振幅,代入公式:心电轴=57.3×ATAN(aVF/I),计算相应的心电轴.比较术前、术后6个月超声心动图结果[左心室收缩未期内径(LVESD)],明确有无左心室逆重构发生.左心室逆重构定义为术后6个月LVESD减小≥15％.根据手术中左前斜位、后前位X线透视片明确左心室导线位置.结果 ①随着右心室起搏成分的减少,左心室成分的增加,QRS波额面电轴逐渐由左偏转为右偏(r,=0.412,P＜0.001),不同的VV间期之间,QRS波额面电轴的分布不全相同(Pearson x2=68.7,P＜0.001);②左心室导线植入部位与心电轴分布之间无明显的相关性(rs=0.08,P=0.149);③在双心室同步起搏模式下,不同QRS波电轴分布范围,左心室逆重构的发生率差异无统计学意义(P=0.115);④12导联同步心电图机自动分析与手动测量的QRS波额面电轴一致性程度一般(ICC=0.563,95％ CI:0.483～ 0.635,F=3.58,P＜0.001).结论 VV间期的改变可使QRS波电轴产生迁移,起搏成分从右心室主导转移为左心室主导时,QRS波额面电轴出现顺时针偏移的现象.QRS波心电轴与左心室导线位置相关性差,仅根据心电轴难以判断左心室导线的位置.单一时间点双心室同步起搏QRS波电轴对于左心室逆重构无预测价值.12导联同步心电图机自动分析出的QRS波额面电轴准确性欠佳.
目的 分析行心髒再同步治療(CRT)的患者在不同起搏模式下的心電圖QRS波電軸的分佈特點,以及與左心室導線位置、左心室逆重構的關繫.比較12導聯同步心電圖機自動分析與手動測量的心電軸的差異.方法 入選2012年11月到2013年6月在上海複旦大學附屬中山醫院行CRT植入的41例患者,分彆記錄患者術後3箇月在單純左心室起搏,左心室提前60ms、40ms、20ms、0ms,右心室提前20ms、40ms,單純右心室起搏的12導聯同步心電圖共326份,記錄12導聯同步心電圖機自動分析得齣的心電軸,同時手動測量I和aVF導聯QRS波的淨振幅,代入公式:心電軸=57.3×ATAN(aVF/I),計算相應的心電軸.比較術前、術後6箇月超聲心動圖結果[左心室收縮未期內徑(LVESD)],明確有無左心室逆重構髮生.左心室逆重構定義為術後6箇月LVESD減小≥15％.根據手術中左前斜位、後前位X線透視片明確左心室導線位置.結果 ①隨著右心室起搏成分的減少,左心室成分的增加,QRS波額麵電軸逐漸由左偏轉為右偏(r,=0.412,P＜0.001),不同的VV間期之間,QRS波額麵電軸的分佈不全相同(Pearson x2=68.7,P＜0.001);②左心室導線植入部位與心電軸分佈之間無明顯的相關性(rs=0.08,P=0.149);③在雙心室同步起搏模式下,不同QRS波電軸分佈範圍,左心室逆重構的髮生率差異無統計學意義(P=0.115);④12導聯同步心電圖機自動分析與手動測量的QRS波額麵電軸一緻性程度一般(ICC=0.563,95％ CI:0.483～ 0.635,F=3.58,P＜0.001).結論 VV間期的改變可使QRS波電軸產生遷移,起搏成分從右心室主導轉移為左心室主導時,QRS波額麵電軸齣現順時針偏移的現象.QRS波心電軸與左心室導線位置相關性差,僅根據心電軸難以判斷左心室導線的位置.單一時間點雙心室同步起搏QRS波電軸對于左心室逆重構無預測價值.12導聯同步心電圖機自動分析齣的QRS波額麵電軸準確性欠佳.
목적 분석행심장재동보치료(CRT)적환자재불동기박모식하적심전도QRS파전축적분포특점,이급여좌심실도선위치、좌심실역중구적관계.비교12도련동보심전도궤자동분석여수동측량적심전축적차이.방법 입선2012년11월도2013년6월재상해복단대학부속중산의원행CRT식입적41례환자,분별기록환자술후3개월재단순좌심실기박,좌심실제전60ms、40ms、20ms、0ms,우심실제전20ms、40ms,단순우심실기박적12도련동보심전도공326빈,기록12도련동보심전도궤자동분석득출적심전축,동시수동측량I화aVF도련QRS파적정진폭,대입공식:심전축=57.3×ATAN(aVF/I),계산상응적심전축.비교술전、술후6개월초성심동도결과[좌심실수축미기내경(LVESD)],명학유무좌심실역중구발생.좌심실역중구정의위술후6개월LVESD감소≥15％.근거수술중좌전사위、후전위X선투시편명학좌심실도선위치.결과 ①수착우심실기박성분적감소,좌심실성분적증가,QRS파액면전축축점유좌편전위우편(r,=0.412,P＜0.001),불동적VV간기지간,QRS파액면전축적분포불전상동(Pearson x2=68.7,P＜0.001);②좌심실도선식입부위여심전축분포지간무명현적상관성(rs=0.08,P=0.149);③재쌍심실동보기박모식하,불동QRS파전축분포범위,좌심실역중구적발생솔차이무통계학의의(P=0.115);④12도련동보심전도궤자동분석여수동측량적QRS파액면전축일치성정도일반(ICC=0.563,95％ CI:0.483～ 0.635,F=3.58,P＜0.001).결론 VV간기적개변가사QRS파전축산생천이,기박성분종우심실주도전이위좌심실주도시,QRS파액면전축출현순시침편이적현상.QRS파심전축여좌심실도선위치상관성차,부근거심전축난이판단좌심실도선적위치.단일시간점쌍심실동보기박QRS파전축대우좌심실역중구무예측개치.12도련동보심전도궤자동분석출적QRS파액면전축준학성흠가.
Objective To analyze the distribution characteristics of QRS frontal axis of patients with cardiac resynchronization therapy(CRT) in the electrocardiograms(ECGs) under different pacing modes and its relationship with left ventricular(LV) lead position,and to assess the value of the QRS axis under simultaneously biventricular pacing mode to predict LV remodeling.Methods Fourty-one patients with complete left bundle branch block were enrolled consecutively at cardiac pacemaker clinic of Zhongshan Hospital between November 2012 and June 2013.Three hundreds and twenty-six ECGs were obtained at the 3-month follow-up after CRT under different settings:single LV output,LV pre-excitation with 60 ms,40 ms and 20 ms,respectively,simultaneous biventricular output,right ventricle pre-excitation with 20 ms and 40 ms,respectively,and single right ventricle output,from 41 CRT patients with complete left bundle branch block before CRT.QRS axis was measured automatically and manually for each ECG.LV remodeling was determined as ≥ 15％ reduction in left ventricular end-systolic diemeter(LVESD) at 6 months.The positions of LV lead were ascertained by fluoroscopies in the postero-anterior and left anterior oblique view during the implantation.Results QRS frontal axis shifted from left to right in accordance with increasing LV pre-excitation interval(rs =0.412,P＜0.001).QRS axis distributions under different interventricular intervals were significantly different(Pearson x2 =68.7,P＜0.001).Distribution of QRS axis was poorly related to the LV lead position(rs =0.08,P=0.149).No difference of the prevalence of LV remodeling was observed among different QRS axis under simultaneous biventricular pacing.The intra-class correlation coefficient of QRS axis measured automatically vs.manually was 0.563 (95％ CI:0.483 ～ 0.635,F=3.58,P＜0.001).Conclusion QRS axis changed when pacing with different interventricular intervals.In general,QRS axis shifted clockwise with gradually increased LV pre-excitation interval.Distribution of QRS axis was poorly related to the LV lead position.QRS axis under simultaneous biventricular pacing at a certain time point was of no value in predicting LV remodeling.The accuracy of QRS axis measured by 12-lead synchronous electrocardiography was only fair.
