心房纖維性顫動假說是多個活化心電訊號之同時再進入(reentry)心房心電訊號纖維傳導的現象,心外心電圖電波的形狀、間隔、傳導速度及初始訊號發生位置皆與心臟電生理特性有直接的關係,可以由這些資訊診斷心律不整的種類並評估其治療效果。本論文擷取狗心臟右心房表面訊號,建立訊號處理推演程序,提出整合心電圖(ECG)與右心房自由壁心外心電訊號彩色定位(epicardial right atrial free wall color mapping)動態模型,表現於三維核磁共振心臟影像(MRI)之概念,將心房切面影像輪廓疊合心外膜心電訊號,成為同步顯示系統模擬心臟電流傳遞,以向量分析法探討心肌電訊號傳導路徑在時間連續性(temporal linking)及心房壁空間上的關連,並依照時序作平面和立體的動態即時顯示(2D & 3D real-time display),便於使用者進行傳導描述、心臟功能評估與觀察自發性節律病灶(focal)產生位置。依此工具本論文評估兩種終止心房纖維顫動藥劑(Procainamide and Sotalol)之功效,其鏈結參數表現時域上心肌電位傳導連續情形,正規化平均鏈結參數(Average of Linking Number)以毫秒為最小時間單位(ms by ms),注射Procainamide之後所有狗的纖維性顫動皆停止(n=7),其平均鏈結增大(變化率95.6%),代表恢復正常竇房節律時訊號趨向穩定,有特定的傳導方向;注射Sotalol後鏈結參數略增、持平或縮小(變化率56.8%,P<0.02),代表訊號紊亂,可證明鏈結參數之鑑別度與正確性。另一驗證方法提供每一心房纖維顫動之心房心電訊號(beat by beat)的向量分佈,化分成四個象限,依其出現比率分析,配合動態系統的向量在各方向的分佈圖定性觀察,可發現心房纖維性顫動的電流傳導有特定方向,證明顫動訊號為非隨機的特性之假說。
The hypothesis of atrial fibrillation is assumed that the electric current reentry in atrium is induced by the potential activity of multiple potential activation centers simultaneously. This project proposes a method with the developed analysis tool to study the relationship of cardiac electrical potential and its anatomical deformation. The primary objective is to develop a data analysis tool to correlate the electrical potential on the reconstructed 3D cardiac anatomic structure. The cardiac electrical potential in present study (Atrial Fibrillation (AF) study) is acquired from a 120 channels surface potential electrode array at right atrium of a dog. The reconstructed 3D cardiac image was acquired from the short axis cardiac image of the studied animal. For the further study of relationship between cardiac potential and anatomy, the project first developed a set of data analysis and display tools for analyzing the multiple channels of electrical potential. The second phase of this project was focusing on developing the electrical potential onto the reconstructed 3D cardiac images. The last phase of the project was the integrated the mapping of body surface potential onto epi-cardio surface. The goal of the project is to integrate the study of electrical current flow on the heart with the hemodynamics of the heart from the cardiac image. At present, the primary projection of this project is to develop a studying tool for locating the initiation point of AF that causes the others heart disease by the electrical current flow. Procainamide and Sotalol, two commonly used medinice, were used to test the developed system and the AF hypothesis. The result of electric potential linking processes at AF termination showed that the increase of 95.6% linkage of Procainamide vs. 56.8% of Sotalol were agreed to the observation and previous report. Therefore, This result suggests that the proposed method demonstrated the possibility of understanding the phenomenon of current reentry.
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