经食管信号平均心电图记录窦房结电图的研究(英文)  

Experimental and clinical study of sinus node electrogram by transesophageal signal averaging technique

作　　者：丁世芳[1] 郭赤[1] 马大波[1] 

机构地区：[1]广州军区武汉总医院心内科,湖北武汉430070

出　　处：《心脏杂志》2007年第6期684-688,共5页Chinese Heart Journal

摘　　要：目的探讨无创性经食管信号平均技术直接记录窦房结电位(SNP)的方法。方法采用自制三导心电微电位检测仪对256例窦房结功能正常者进行检测,其中男142例,女114例,年龄10～74(44.2±12.4)岁。将食管导联的信号放大(增益达到100μV/cm)、滤波(0.1～50)Hz,16位模/数(A/D)转换,系统采样频率2kHz,对食管SNP进行信号平均,并通过同步信号平均对人食管和心内膜所记录的SNP,犬食管和心外膜所记录的SNP进行分析研究。结果记录到食管SNP189例(74%),所测信号平均食管SNP为P波前的低幅、低频波,可见有2种形态:园顶型(60%)和上斜型(40%);窦房传导时间为(83.3±26.7)ms,分布范围为(23～118)ms;波幅为(3.5～27.7)μV;dv/dt为(0.43～1.93)mV/s。结论在适当滤波、高增益和抗基线漂移技术条件下,利用经食管信号平均技术,大多数窦房结功能正常的患者可直接记录到食管SNP。AIM To develop a noninvasive transesophageal signal averaging technique for direct recording of sinus node electrogram. METHODS Sinus node electrograms were recorded by conventional transesophageal technique from 256 patients （ 142 male and 114 female, aged from 10 to 74 （ mean 44.2 ± 12.4）. The signals from lead I, surface averaged lead and esophagus averaged lead were amplified （up to 100 μV/cm）, filtered （0.1 -50）Hz, AD converted to 16-bit accuracy at a sampling rate of 2 kHz and averaged by using the three-channel low-noise amplifier. To verify sinus node potentials recorded by esophageal lead, electric activities of esophagus/sinus node area and fight atrium were simultaneously recorded in humans and in dogs by intracardiac direct record method. RESULTS The signal averaged esophageal sinus node potentials were deflections of low-amplitude and low-frequency preceding the P wave. Two morphologies, the domed wave （114 of 189 patients, 60% ） and the smooth upstroke slope （75 of 189 patients, 40% ） were seen. The directly recorded sinoatrial conduction time was （83.3 ± 26.7 ） ms, ranging from 23 to 118 ms, amplitude was （ 3.5 - 27.7 ） μV and dv/dt was （0.43 - 1.93 ） mV/s. The sinoatrial conduction time recorded by the transesophageal catheter technique was well comparable to that （80.4 ± 18.1 ） ms recorded by the transvenous catheter method. CONCLUSION Signal averaged sinus node electrogram can record sinus rhythm in most patients with normal sinus node function. Poper filter settings, high amplification and anti-drift technique are important in recording signal averaged esophageal sinus node electrogram.

关 键 词：窦房结电图 信号叠加 食管导管 

分 类 号：R540.41[医药卫生—心血管疾病]