單極誘導心電圖及びベクトル心電圖の併用による心室内興奮傳播過程の研究 : 第1部 正常例について 第2部 心室肥大, 脚ブロック及び心室性期外收縮
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Many researches have been done for the analysis of the ventricular activation process by means of extremity lead ECG or unipolar chest lead ECG. But those by means of extremity lead ECG and too rough to discuss the excitation process, and those by means of unipolar lead ECG are too prejudiced. According to our previous report on the relationship between the unipolar lead ECG and VCG, one can analyse the intraventricular activation process far minutely. So tried the analysis of intraventricular excitation process by means of combined use of the unipolar lead ECG and VCG.Method 20 unipolar lead ECG and the lead points of fronatl, horizontal and sagittal planes of Vectorpolyogram by Toyoshima were taken simultaneously with V_F and the electrical potentials at each instant in QRS duration were measured standardizing the main peak of QRS in V_F ECG. From these electrical potentials obtained by measurement, I constructed Vectorpolyograms in three planes, and compared them with those recorded by polyography. When they were coincident very closely each other, they were used for the analysis of intraventricular activation process. Theoretically, the constructed VCG must be coincident with polyograms, but for several reasons, especially for the difficulty of accurate potential measurement of synchronous instant they were not always coincident each other. Materials.The materials were 40 normal adults, 7 patients with ventricular hypertrophy, 4 patients-with bundle branch block, and 1 patient with ventricular premature beat.Results obtained In normal adults, the heart region depolarized at first was subendocardial muscles of either side of the septum, and then those of free walls. The activation in subepicardial muscle began earliest at the anterior aspect of right ventricle and then extended radially. The apical portion was earlier than the basal portion. Activation in subepicardial muscle was not fired after the accomplishment of activation in subendocardial muscle but was fired always on the way of activation of subepicardial muscle. Generally, the subepicardial muscles in diaphragmatic and basal region were activated lastly.The depolarization in the heart with ventricular hypertrophy developed in the order at first, but the influence of the hypertrophied ventricular walls the VCG was recorded in its specific pattern, and the last portion of the activation was the posterolateral subepicardial muscle at the hypertrophied wall.In the heart with bundle branch block, the subednocardial muscles of the septum and of the anterior free wall at the intact side were activated in the first and then the subepicardial musles of the same side. The depolarization of the subendocardial musle of the posterior free wall of the block side began to depolarize about this time and extend gradually to anterior. The subepicardial muscle depolarized in order of back to front and apparent delay of inscription of QRS loop was marked in this period. The occurrence of this delay was the difference of b. b. b. from hypertrophy of ventricle.In the case of ventricular premature beat of right ventricular origin, the activation of the right ventricle was earlier than that of the left ventricle, and the order of affection in the left ventricle, differing from that in the left bundle branch block, was nearly the same with that in normal heart. Namely from the anterior to the posterior and from the apex to the base.
- 社団法人日本循環器学会の論文
- 1955-09-20
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関連論文
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