基礎心疾患を伴わない心室性期外収縮の体表面電位図による発生源の推定
明らかな基礎心疾患を有しない患者の心室性期外収縮(VPB) 100例の体表面電位図(MAP)を記録し,その発生源の推定を行なつた.またおのおののVPB発生源毎に,標準12誘導心電図の特微的所見を明らかにした.発生源の推定は,先に我々が行なつた左右心室の心内外膜の種々の心室部位のペースメーカー刺激時のMAP所見との対比によつた.対象は,男52例,女48例で,年令は3才から76才(37.0±19.5才, mean±SD)であつた. QRS MAPのパターンを9型に分類し, VPB発生源の推定を行なつた(()内:発現頻度).すなわち, I型:右室流出路(56%), II型:右脚(5%), III型:...
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| Published in | 日本内科学会雑誌 Vol. 73; no. 6; pp. 807 - 816 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
1984
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| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.73.807 |
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| Abstract | 明らかな基礎心疾患を有しない患者の心室性期外収縮(VPB) 100例の体表面電位図(MAP)を記録し,その発生源の推定を行なつた.またおのおののVPB発生源毎に,標準12誘導心電図の特微的所見を明らかにした.発生源の推定は,先に我々が行なつた左右心室の心内外膜の種々の心室部位のペースメーカー刺激時のMAP所見との対比によつた.対象は,男52例,女48例で,年令は3才から76才(37.0±19.5才, mean±SD)であつた. QRS MAPのパターンを9型に分類し, VPB発生源の推定を行なつた(()内:発現頻度).すなわち, I型:右室流出路(56%), II型:右脚(5%), III型:右室流入路(7%), VIIR型:右室心尖部(1%), IV型:左室後基部(2%), V型:左室前側壁基部(4%), VIa型:左脚後枝(10%), VIb型:左脚前枝(11%), VIIIa型:心室中隔前上部(4%)であつた.これらのうち,右室源性は69%,左室源性は27%,中隔源性は4%であつた.年令分布では, II型, VIa型, VIb型等の特殊伝導系附近に起源を有すると考えられたVPBは,若年者に多く, IV型, V型, VIIIa型等の左室基部あるいは中隔上部起源のものは高年令者に頻度が高かつた.標準12誘導心電図において,右室源性VPBは左脚ブロック.左室源性VPBは右脚ブロック.中隔源性VPBは両脚ブロックに近いパターンを示した.また,それぞれVPB発生源に特有の電気軸を認め, QRS持続時間にもいくつかの発生源については,特徴がみられた. |
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| AbstractList | 明らかな基礎心疾患を有しない患者の心室性期外収縮(VPB) 100例の体表面電位図(MAP)を記録し,その発生源の推定を行なつた.またおのおののVPB発生源毎に,標準12誘導心電図の特微的所見を明らかにした.発生源の推定は,先に我々が行なつた左右心室の心内外膜の種々の心室部位のペースメーカー刺激時のMAP所見との対比によつた.対象は,男52例,女48例で,年令は3才から76才(37.0±19.5才, mean±SD)であつた. QRS MAPのパターンを9型に分類し, VPB発生源の推定を行なつた(()内:発現頻度).すなわち, I型:右室流出路(56%), II型:右脚(5%), III型:右室流入路(7%), VIIR型:右室心尖部(1%), IV型:左室後基部(2%), V型:左室前側壁基部(4%), VIa型:左脚後枝(10%), VIb型:左脚前枝(11%), VIIIa型:心室中隔前上部(4%)であつた.これらのうち,右室源性は69%,左室源性は27%,中隔源性は4%であつた.年令分布では, II型, VIa型, VIb型等の特殊伝導系附近に起源を有すると考えられたVPBは,若年者に多く, IV型, V型, VIIIa型等の左室基部あるいは中隔上部起源のものは高年令者に頻度が高かつた.標準12誘導心電図において,右室源性VPBは左脚ブロック.左室源性VPBは右脚ブロック.中隔源性VPBは両脚ブロックに近いパターンを示した.また,それぞれVPB発生源に特有の電気軸を認め, QRS持続時間にもいくつかの発生源については,特徴がみられた. |
| Author | 林, 博史 宮地, 恭一 小島, 春紀 大杉, 茂樹 石川, 富久 上松, 治儀 外畑, 巌 高見, 和秀 矢部, 誠太郎 |
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| References | 8) Uematsu H, et al: Ventricular activation sequence in patients with pacemaker implanted at different sites determined by body surface isopotential maps. Proceedings of the VIth World Symposium on Cardiac Pacing. Montreal, 1979, 8, Chapter 2-3. 16) Scher AM, and Young AC: Spread of excitation during premature ventricular systoles. Circ Res 3: 535, 1955. 20) Sharma P and Chang EK: Clinical implication of surface morphology of ventricular premature contractions. J Electrocardion 13: 331, 1980 3) Mautner B and Girotti AL. Premature ventricular beats: Experimental study. Amer Heart J 85: 389, 1973 10) Talbot S, et al: Vectorcardiographic features of ventricular extrasystoles correlated with conventional scalar electrocardionraphic interpretation. Brit Heart J 40: 883, 1978. 18) Spach MS and Barr RC: Analysis of ventricular and epicardial potential distributions for ectopic beats in the intact dog. Circ Res 37: 830, 1975. 2) Klein MD, et al: Vectorial characteristics of ventricular extrasystoles stimulated during cardiac catheterization. J Electrocardiol 9: 103, 1976. 5) Manning GW, et al: Electrocardiongraphic differentiation between ventricular ectopic beats from subjects with normal and diseased hearts. Acta Cardiol 23: 462, 1968. 17) Castellanos A Jr: The electrocardiogram and vectorcardiogram of ectopic ventricular beats. Acta Cardiol 28: 562, 1973. 19) 山田和生,他:心臓の興奮前面と体表面心臓電位分布図の極大と極小との関係.名古屋大学環研年報27: 99, 1976. 4) Mower MM, et al: Unusual patterns of conduction produced by pacemaker stimuli Amer Heart J 74: 24, 1967. 7) 山田和生:体表面心臓電位分布図.山田和生編,最新心電図・ベクトル心電図学,メディカル出版,東京, 1978, p811. 13) Hayashi H, et al: Identification of the site of origin of ventricular premature beats and its activation sepuence by body surface isopotential map. Jpn Circ J 45: 1182, 1981. 12) Lepeschkin E: Mapping of stimulus distribution from implanted cardiac pacemakers as a method of studying ECG transfer factors. Adv Cardiol 10: 77, 1974. 15) Spach MS, et al: Origin of body surface QRS and T wave potentials from epicardial potential distributions in the intact chimpanzee. Circulation 55: 268, 1977. 11) Sano T, et al: The vectorcardiogram of ventricular premature beats -An analysis of vectorcardiograms from 100 cases taken by Frank's method-. Jap Heart J 8: 388, 1967. 14) Abildskov JA, et al: Distribition of body surface potentials with experimentally induced multiple cardiac generators. Adv cardiol 10: 69, 1974. 1) Rosenbaum MB: Classification of ventricular extrasystoles according to form. J Electrocarkiol 2: 289, 1969. 6) Lewis S, et al: Significance of site of origin of premature ventricular contractions. Amer Heart J 97: 159, 1979. 9) 阿久津晄:心電図,ベクトル心電図による心室期外収縮の発生部位判定に関する実験的研究.日循誌33: 991, 1969. |
| References_xml | – reference: 8) Uematsu H, et al: Ventricular activation sequence in patients with pacemaker implanted at different sites determined by body surface isopotential maps. Proceedings of the VIth World Symposium on Cardiac Pacing. Montreal, 1979, 8, Chapter 2-3. – reference: 2) Klein MD, et al: Vectorial characteristics of ventricular extrasystoles stimulated during cardiac catheterization. J Electrocardiol 9: 103, 1976. – reference: 13) Hayashi H, et al: Identification of the site of origin of ventricular premature beats and its activation sepuence by body surface isopotential map. Jpn Circ J 45: 1182, 1981. – reference: 7) 山田和生:体表面心臓電位分布図.山田和生編,最新心電図・ベクトル心電図学,メディカル出版,東京, 1978, p811. – reference: 1) Rosenbaum MB: Classification of ventricular extrasystoles according to form. J Electrocarkiol 2: 289, 1969. – reference: 18) Spach MS and Barr RC: Analysis of ventricular and epicardial potential distributions for ectopic beats in the intact dog. Circ Res 37: 830, 1975. – reference: 20) Sharma P and Chang EK: Clinical implication of surface morphology of ventricular premature contractions. J Electrocardion 13: 331, 1980 – reference: 5) Manning GW, et al: Electrocardiongraphic differentiation between ventricular ectopic beats from subjects with normal and diseased hearts. Acta Cardiol 23: 462, 1968. – reference: 19) 山田和生,他:心臓の興奮前面と体表面心臓電位分布図の極大と極小との関係.名古屋大学環研年報27: 99, 1976. – reference: 11) Sano T, et al: The vectorcardiogram of ventricular premature beats -An analysis of vectorcardiograms from 100 cases taken by Frank's method-. Jap Heart J 8: 388, 1967. – reference: 15) Spach MS, et al: Origin of body surface QRS and T wave potentials from epicardial potential distributions in the intact chimpanzee. Circulation 55: 268, 1977. – reference: 14) Abildskov JA, et al: Distribition of body surface potentials with experimentally induced multiple cardiac generators. Adv cardiol 10: 69, 1974. – reference: 17) Castellanos A Jr: The electrocardiogram and vectorcardiogram of ectopic ventricular beats. Acta Cardiol 28: 562, 1973. – reference: 3) Mautner B and Girotti AL. Premature ventricular beats: Experimental study. Amer Heart J 85: 389, 1973 – reference: 10) Talbot S, et al: Vectorcardiographic features of ventricular extrasystoles correlated with conventional scalar electrocardionraphic interpretation. Brit Heart J 40: 883, 1978. – reference: 6) Lewis S, et al: Significance of site of origin of premature ventricular contractions. Amer Heart J 97: 159, 1979. – reference: 12) Lepeschkin E: Mapping of stimulus distribution from implanted cardiac pacemakers as a method of studying ECG transfer factors. Adv Cardiol 10: 77, 1974. – reference: 16) Scher AM, and Young AC: Spread of excitation during premature ventricular systoles. Circ Res 3: 535, 1955. – reference: 9) 阿久津晄:心電図,ベクトル心電図による心室期外収縮の発生部位判定に関する実験的研究.日循誌33: 991, 1969. – reference: 4) Mower MM, et al: Unusual patterns of conduction produced by pacemaker stimuli Amer Heart J 74: 24, 1967. |
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| Snippet | 明らかな基礎心疾患を有しない患者の心室性期外収縮(VPB) 100例の体表面電位図(MAP)を記録し,その発生源の推定を行なつた.またおのおののVPB発生源毎に,標準12誘導心電... |
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| Title | 基礎心疾患を伴わない心室性期外収縮の体表面電位図による発生源の推定 |
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