Method for localizing additional conducting paths in wolff-parkinson-white syndrome cases using vector electrocardiograms

FIELD: medicine.

SUBSTANCE: method involves recording cardiac biopotentials with vector electrocardiograph, processing and visualizing signal with graphical plane integral cardiac electric vector projections (vector electrocardiograms) being built and analyzed. Shape, QRS-loop value and vector orientation-recording process are determined. Analysis is based on planar vector electrocardiograms in horizontal, frontal and sagittal planes and in spatial 3-D-form. Vector loop direction is studied in X-,Y-,Z-axis projections, values, dynamics and localization are evaluated in resulting integral cardiac electric vector delta-vector space. To do it, QRS-loop is divided into four segments, one of which characterizes excitation in middle part of axial partition surface, the second one is related to excitation in lower ventricular septum one-third with cardiac apex being involved and the third and the fourth one is related to excitation in basal parts of the left and right heart ventricles. Delta-vector existence and its magnitude are determined from changes in loop segment localization when compared to reference values.

EFFECT: improved data quality usable in planning surgical treatment.

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The method relates to medicine, particularly cardiology (Arrhythmology), and can be used for non-invasive topical diagnostics additional pathways syndrome Wolff-Parkinson-white (WPW).

Known methods for non-invasive diagnosis of WPW syndrome electrocardiogram (ECG) and the vector electrocardiogram (VACG).

For the prototype accepted way of recording, processing and graphical representation of biopotentials heart with obtaining vector loops P, QRS, T in the standard planes: horizontal, frontal and sagittal, i.e. the vector electrocardiogram their subsequent analysis [1].

The disadvantage of the method adopted for the prototype is the lack of necessary information and, as a result, the inability to localize additional pathways in WPW syndrome. This method only allows to diagnose the WPW syndrome and differentiate changes that occur when the WPW syndrome from changes caused by myocardial infarction, hypertrophy of the ventricles of the heart and the blockades of the proceedings.

The purpose of the invention is the possibility of localization of additional pathways in WPW syndrome in VAKH to improve the efficiency of surgical treatment.

The essence of this invention is as follows.

Upon excitation of the myocardium occurs peraonalitiea field, characterized by the integral of the electric vector of the heart (IES), the end of which during the cardiac cycle describes in space a complex curve - loop vector, which is registered with the vector cardiograph [2, 3]. Methods vector electrocardiography, due to the possibility of a spatial visualization of IMS, allows to estimate its magnitude and localization in space at different points in the electrical systole of the ventricles.

Delta-wave that occurs on the lines of standard lead ECG 12 at WPW syndrome, from the point of view of the dipole theory of heart electrogenesis and the concept of Grant-Penaloza-Tranchesi of existence in the process of electrical systole of the ventricles of the three major electric vectors, components of IMS (vector excitation interventricular septum (1), tips and free walls of the ventricles (2), basal heart (3) [1], figure 1), represents nothing else than the projection of the additional Delta (Δ)-vector. Start, direction and localization of Δ-vector depend on the anatomical site of practicaly, which in turn indicates the localization DPGS. VEKH registered with WPW syndrome are a result of the addition Δ-vector with IMS.

The trajectory loops on WAKH in all areas is accompanied by the numerical analysis.

A the invention is achieved by the following actions.

The action potentials of the heart are recorded vector cardiograph using a system of orthogonal electrode lead. After processing and visualization of the signal, obtained by projection of IMS on the frontal, horizontal and sagittal plane and in space - plane VAKH and 3D-shape, respectively. Allocated vector loop, resulting in depolarization of the Atria (P), ventricles (QRS) and ventricular repolarization (T). Further analysis vector QRS loop. Analyzed values, dynamics and localization in space of the result of IAWS and Δ-vector arising from the operation of additional atrioventricular connection (DPGS). The analysis is carried out in accordance with the dipole theory of heart electrogenesis and the concept of Grant-Penaloza-Tranchesi. Revealed typical changes trajectory QRS loops that occur when operating DPGS. Determine the scope of practicali. Formulated conclusion.

Vector analysis of the QRS loop is performed as follows.

Figure 2 presents QRS loop in space and its projection in the standard frontal, horizontal and sagittal planes, which are observed in the propagation of excitation in the ventricles are normal.

The course record QRS loop in a clockwise direction in the sagittal plane and counterclockwise in the horizon of the through plane. In the frontal plane QRS loop uninformative. The loop is tilted back, left and down.

Divide loop micro four conditional plot points a, b, C (C'), D. At each site it is possible to note the predominance of excitation in certain anatomical regions of the left and right ventricles. 1 shows a diagram of the anatomical localization of the above vectors. For convenience and clarity, holding vector analysis diagram of the structure of the heart is represented in the horizontal plane and in the plane XZ, forming an angle of 45° frontal plane.

Section AB on this VEKH reflects the localization and direction in space of the vector 1, which occurs in the middle part of the left septal surface and directed to the base of the anterior papillary muscle of the right ventricle, is oriented forward, up or down (depending on the position of the heart). In the scheme vector 1 are directed downwards and straight forward on the Z axis, due to the anatomical location of the heart in the chest cavity. Then the vector 1 in its development begins to deviate down, left, and back and gradually transformed into the vector 2. This process reflects the plot entirely on VAKH, which is caused by the spread of excitation along the lower third of the interventricular septum with the capture of the apex of the heart.

In the future, is PE is ehod excitation on the free wall of the ventricle: the left and right forming vectors 2' and 2" respectively. Since the mass of the myocardium of the left ventricle substantially greater than the mass of the myocardium of the right ventricle, then the distribution of excitation on the walls of the ventricles is dominated by the potentials of the left ventricle. This fact is explained by the localization in space of the vector 2, which, as a result when adding vectors 2' and 2" by the rule of the parallelogram, oriented to the left, back and bottom (site SS').

The following sections C, D and DA characterize the localization in space of the vector 3. This vector is caused by the excitation of the basal left (3') and right (3") of the ventricles, is the result of the addition of vectors 3' and 3". He turns right, up and forward until the end of the cycle of excitation.

Figure 3 shows a typical spatial VECG (3D form) and its projection on the plane at the left verhnemamon DPIS, which is situated between the left atrium and left ventricle, leads to premature initiation of basal area Verkhneportovaya wall of the left ventricle. The course record QRS loop in the clockwise direction in the sagittal plane and counterclockwise in a horizontal plane. The loop is shifted compared to the norm of the forward, left and down.

Loop QRS divided into distinctive sections AB, BC, SS', S A. Diagram of the structure of the heart with a vector analysis are presented in figure 4. On the Hema DPGS marked with a bold line in the plane-XZ - point in the horizontal plane. In the analysis used similar schemes in other planes.

On WAKH in the sagittal plane compared to the norm, there is a shift of area AB a few down. This change can be explained by the following features of distribution of excitation in the myocardium of the ventricles as a result of practicaly due DPGS basal area Verkhneportovaya wall of the left ventricle, there are additional vectors. Denote them: 1Δ' - vector due to the spread of excitation on the top-side region of the left ventricle, 1Δ" - vector arising from the spread of excitation on paraseptal region of the left ventricle. With the addition of vectors is formed resulting vector 1Δthat is oriented down, left and forward (figure 4).

Almost simultaneously with the formation of Δ-vector is the spread of excitation conduction system of the heart with the formation of the vector 1. In the result of the addition of the vector 1Δ and the vector 1 is formed resulting vector 1'Δ. Its localization in space is clearly reflected by the area AB QRS loop in the sagittal and horizontal planes. The change in the location of area AB in comparison with the norm due to the interaction of waves of excitation that occurs in the heart, including function is neraudia DPGS, in the beginning of the process of depolarization.

The next part of the armed forces reflects the prevailing vector potentials 2. Despite its slight shift forward in the sagittal and horizontal planes, it is not significantly different from those in normal. Its localization in space is also caused by the interaction of waves of excitation. When different velocity of propagation of excitation along and across the muscle fibers it becomes clear that for one and the same time when the spread of excitation conduction system of the heart and myocardium in the process of depolarization involved more anatomical structures of the heart, namely the lower third of the interventricular septum and the cap, compared with a plot of excitation wall of the left ventricle due to the extra pathway. Therefore, the potentials of the vector 2 largest will prevail over potentials Δ-vector. Analysis VEKH shows that, despite such a clear prevalence of the vector 2, Δ-vector persists and continues to influence the localization in space of IMS. Wave excitation, forming Δ-vector, continues to spread on the wall of the left ventricle until then, until her interaction with the oncoming wave of excitation propagating along the conduction system of the heart and myocardium.

Localization uchastkapo QRS near point reflects the continuing process of interaction of waves of excitation in the wall of the left ventricle. On WAKH in the sagittal and horizontal planes plot near point C, compared to normal, shifted forward and to the left. These changes are attributable to the following: as a result of the spread of excitation, caused by the functioning DPGS, in the wall of the left ventricle vector 1Δthat growing up goes into a 2D vector, the orientation down, forward. At the same time, as a result of transfer of excitation from the apex of the heart on the wall of the left and right ventricles in normal formed two vectors: 2' - in the left ventricle and 2" in the right ventricle. However, the localization in space of vector 2' is influenced by the vector 2Δexisting in the same ventricle. With the addition of 2' and 2Δ get the resulting vector 2'Δthat compared with the vector 2' initially more sharply falls down, but in General is weakened, especially in the development of ago, due to mutual compensation of wave excitation. Upon further addition of vectors 2'Δ and 2 we get the result vector of 2 (figure 4). Its formation and localization in space at different points in time reflect the plots SU and SS' QRS loop in the sagittal and horizontal planes.

At the further spread of excitation in the myocardium of the ventricles are normal, in accordance with the accepted concept should form the vector 3. But by the time re the ode excitation with free walls of the ventricles on their basal areas, part of the basal segment is more powerful left ventricle was already excited, so the vector 3' for this type of localization DPGS significantly weakened. Vector 3", due to disturbances in the basal sections of the right ventricle, does not differ from that in the norm. When adding vectors 3' and 3" is formed, the resulting basal vector 3, which in this case has changed its direction towards the right ventricle (figure 3). Plot S And VAKH in the sagittal and horizontal planes shifted during this forward and to the side of the right ventricle.

Conclusion: according to the detected deviation from the norm, namely the offset sections AB down and forward SA, DPGS localized in Verkhneportovaya region of the left ventricle.

Using the proposed method of vector analysis to determine the localization DPGS on preoperative stage, to reduce the risk of complications during surgery by reducing operative time, duration of fluoroscopy and anesthesia, which increases the efficiency of surgical treatment. In addition, VAKH anatomically quite clearly reflects the processes of depolarization of the myocardium in the WPW syndrome, which also leads to an increase in the accuracy of topical diagnostics of additional pathways.

Sources of information

1. Drubchen SL fundamentals of clinical electrophysiology and Biophysics. M: Medicine 1968; 101-367.

2. Volobuev A.N., Becucci V.N., Hooks N.N., Romanchuk P.I. Spatial vectorillustration. Cardiology 2003; 4:52-54.

3. Gajeva FU, Grigoryants R.A., Masenko VP, Dr. A.A. Electrocardiographic system leads. Tula: the research Institute of the NRM 1996; 116.

The method of localization of the extra pathway syndrome Wolff-Parkinson-white by recording action potentials of the heart using vectorcardiography, processing and visualization of the signal, obtaining a graphic planar projections integral of the electric vector heart vector electrocardiogram and their analysis with the definition of the form of recording the magnitude and orientation of the vector of the QRS loop, wherein the analysis is performed on planar vector-electrocardiograms in the horizontal, frontal and sagittal planes and spatial 3D form, determine the direction vector of the loop in the X, Y, Z, assess the magnitude, dynamics and localization in space of the result the integral of the electric vector of the heart and the Delta vector, which vector QRS loop is divided into four sections, one of which characterizes the excitation in the middle part of the axial septal surface, the second excitation in the lower third of the interventricular septum with the capture of the apex of the heart, third and fourth - vazbu the Denia respectively basalt departments left and right ventricles of the heart, determine the presence of the Delta vector and the magnitude of the change in the location of the plot hinges when compared with the norm.



 

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