Circumscribed areas of injured myocardium which lead to late ventricular depolarization represent the pathologic-anatomic substrate for reentry mechanisms potentially capable of propagating ventricular tachycardia at the ventricular level. If the myocardial area from which delayed ventricular depolarization and, consequently, late potentials eminate, exceeds a critical minimal size, documentation of such signals can not only be achieved with direct endocardial mapping or catheter mapping but also by means of special high-resolution ECG techniques from the body surface. Since high amplification of the conventional ECG results in registration of noise signals in amplitude of up to 50 microV, late potentials with their amplitudes at the body surface ranging from 5 to a maximum of 20 microV, can only be discriminated after substantial enhancement of the signal-to-noise ratio. The noise arises from no less than three sources: physiologic noise, for example, from muscle activity; electronic noise from amplifiers and background noise of 50 or 60 Hz, respectively. To improve the signal-to-noise ratio, currently three methods are employed: sequential or temporal signal averaging, spatial signal averaging and fast Fourier transformation analysis of the frequency spectrum of the highly-amplified ECG. Temporal signal averaging has the purpose of smoothing randomly-occurring background noise and, at a specified point in time of the ECG cycle, to sum the signal incurred. The effectivity of this technique, however, is subject to certain conditions: the signal to be registered and the background noise must be independent from each other, the noise must be stationary and show normal random distribution, the signal of interest must be periodic and/or coupled with a fixed interval to a point in the ECG cycle which can be used as a trigger. The quality of the averaged signal is dependent on trigger stability. There are three approaches to trigger processing: voltage threshold determination, slope detection and the pattern matching technique, the accuracy, reliability and time-consumption of which increases in the order listed. A trigger stability of +/- 0.5 ms is necessary to detect ventricular late potentials with sufficient sensitivity and without meaningful deformation or attenuation of their form and temporal extent. Intercurrently, a number of commercially-acquirable signal averaging computers have been made available which differ with respect to registration and analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

译文

:导致晚期心室去极化的受伤心肌的边界区域代表折返机制的病理解剖学底物,其可能能够在心室水平传播心室性心动过速。如果延迟心室去极化并因此消除晚期电位的心肌面积超过了临界最小尺寸,则不仅可以通过直接心内膜标测或导管标测,而且可以通过特殊的高分辨率心电图技术来实现此类信号的记录从身体表面。由于常规ECG的高放大倍数导致噪声信号的振幅高达50 microV,因此只有在大幅增强信号后才能识别出体表振幅范围从5到最大20 microV的晚期电势。噪声比。噪声来自至少三个来源:生理噪声,例如,来自肌肉活动;以及放大器的电子噪声和50或60 Hz的背景噪声。为了提高信噪比,目前采用三种方法:顺序或时间信号平均,空间信号平均以及对高度放大的ECG频谱的快速傅里叶变换分析。时间信号平均的目的是平滑随机发生的背景噪声,并在ECG周期的指定时间点对产生的信号求和。但是,此技术的有效性受某些条件的限制:要记录的信号和背景噪声必须彼此独立,噪声必须稳定且显示正态随机分布,感兴趣的信号必须具有周期性和/或以固定间隔与ECG周期中的某个点配合使用,可以用作触发条件。平均信号的质量取决于触发的稳定性。共有三种触发处理方法:电压阈值确定,斜率检测和模式匹配技术,其准确性,可靠性和时间消耗按列出的顺序增加。 0.5 ms的触发稳定性对于以足够的灵敏度检测心室晚期电位,而不会对其形式和时间范围造成有意义的变形或衰减是必要的。同时,已经提供了许多在商业上可以买到的信号平均计算机,它们在注册和分析方面有所不同。(摘要截断为400字)

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