壁内誘導心電圖の研究(第1報) : 實驗的研究

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Recently, a new method of studying cardiac functions through the use of intramural lead electrocardiograms has been introduced. This method is especially useful in analysing local activity of the heart muscles and in studying the propagation process of ventricular activation. In this article, findings of the unipolar intramural lead ECG's at various points in the cannine ventricle, excepting the ventricular septum, under various conditions are reported. The electrodes used in this experiment were specially designed by Toyoshima, each consisting of six fine insulated wires with a small exposed region at each end.As a reference, leads II were always recorded simultaneously with the other six intramural leads.At the instant an electrode was inserted into the heart muscle, a monophasic wave with a significant S-T segment elevation was recorded, but after a few seconds this elevation began to decrease and finally disappeared altogether after several minutes. Slight elevation of the S-T segment occasionally was observed however even after ten minutes, and this slight elevation didn't disappear completely even an hour or more but kept the same elevation magnitude. In the left ventricular free wall, except in the apical region, the recorded ECG'S showed QS, rS, RS and Rs patterns respectively as the electrode moved from the endocardial to the epicardial surface through the ventricular wall, however, in the right ventricular free wall, they showed QS, rS and RS patterns and hardly an Rs pattern even in the epicardial surface. Consequently, the inner halves or more of both ventricular walls corresponded to the QS-zone displaying QS pattern and the remaining portions of the walls, to the RS zone displaying rS, RS, or Rs pattern; but, the ratio of the thickness of the QS zone to its corresponding RS zone was variable according to the portion of the ventricular wall.In order to examine the activation time and the conduction rate of excitation, the time duration from the beginning of the QRS complex to the onset of the intrinsic deflection was measured. In the RS zone in the direction rectangular to the epicardial surface, excitation is transmitted at the rate of 30〜90 cm/sec. from within to without. From the fact that the leads at a given level in the QS-zone showed nearly the same activation time, it was supposed that the Purkinje's network would play an important role in the appearance of the QS pattern in the QS-zone.In the apical region, the ratio of the thickness of the QS-zone to the RS-zone was larger than that in any other portion of the free wall. Although QS waves could be observed throughout most of a papillary muscle, rS waves almost always were recorded in the endocardial part near the head of the papillary muslce. This fact possibly would be responsible for the absence of Purkinje's fibres in such a part of the papillary muscle.When tracings from the infarcted area, experimentally reproduced, were recorded by use of electrodes inserted into the ventricular wall from an epicardial surface where QS or QR pattern was recorded, the following changes were observed.In through-and-through infarction, every lead displayed almost identical QS waves. However, in patchy infarction, occasionally there was a lead showing a qrS or qRS pattern resulting from a living muslce in contact with the electrode. In an infarcted area, the ECG's from a fibrotic area showed neither an injury current nor an ST deviation, and showed a lower voltage than normal.During ventricular fibrillation two types of fibrillation waves were observed. One types showed a synchronization in their rhythms, the other type showed asynchronization to each other.
社団法人日本循環器学会の論文
1958-11-20

壁内誘導心電圖の研究(第1報) : 實驗的研究

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