心室颤动初始节律的动态心电图观察  

Ambulatory monitoring studies on the initial rhythm of the spontaneous ventricular fibrillation

作　　者：郭成军[1] 张英川[1] 刘冰[1] 郭晋萍[1] 徐霞[1] 裴莉[1] 陈晖[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏电生理科,100029

出　　处：《中华心血管病杂志》2004年第8期689-693,共5页Chinese Journal of Cardiology

摘　　要：目的 探讨心室颤动(室颤)初始心搏与室性早搏(室早)或室性心动过速(室速)是否同源,为消融室颤提供基础数据。方法 选择室颤高危患者记录动态心电图,比较室颤初始心搏与室早或室速各导联QTS形态的一致性,形态一致者起源点相同,作初步定位。结果 96例患者中,28例检出60例次室颤,55例次发作初始的3～53个心搏为有序的快速室速或扑动样节律,平均周长(185±36.4)ms。12例次自行终止,持续1.2-21.6(6±8.4)s;40例次电击终止;8例未终止死亡。1例次初先室颤,中转为室速,后又转为室颤。室颤自行终止与非自行终止者相比,初始节律的周长差异无显著性[(202±42.6)ms与(182±38.6)ms,P=0.066]。50例次室颤可见与其初始QRS形态一致的单发、成对室早或室速。48例次初始心搏为R-on-T。42例次初始QRS无伪差干扰,起源点呈聚集而非随机分布,18例次对应于右室前乳头肌区,6例次对应于右室流出道,11例次对应于左室前乳头肌区,7例次对应于左室后乳头肌区。9例多次室颤,7例有2-5种QRS形态。22例可见与室颤初始QRS态不同、未触发室颤的室早或室速。结论 室颤与某些室早或室速同源,起源点聚集分布,好发于乳头肌周围,以室早或室速起源为消融靶点有望消除室颤。自行终止的短阵室颤并不少见,及时识别有着生命攸关的临床意义。Objective To provide the basic data for developing strategies to abolish ventricular fibrillation( VF) , the similarity of the origin among the initial beat of the spontaneous VF, ventricular premature beat ( VPB ) and ventricular tachycardia ( VT ) was investigated. Methods Holter electrocardiography with 12-leads were recorded in patients with high risk of VF. The QRS morphology was compared between the initial beat of VF, VPB and VT. Those with an identical QRS morphology were assumed to have a common origin. Results There were 50 men and 46 women, with the mean age of (55 ± 10.2) years. Sixty-nine patients had organic heart diseases. Twenty-eight patients had 60 episodes of spontaneous VF during Holter monitoring. The first 3 to 53 beats of VF showed organized rapid VT or flutter-like activity in 55(91% )episodes of VF, with the mean cycle length of (185 ± 36. 4) ms. VF terminated spontaneously in 12 episodes, lasting (6 ± 8.4) seconds (ranged from 1.2 to 21.6 seconds). VF terminated with electrical shock in 40 episodes. VF caused death in 8 patients. No significant difference was found in the cycle length of initial rhythm between VF with or without spontaneous termination [ (202 ± 42.6)msvs (182 ±38. 6)ms, P = 0.066]. The single, paired or runs of VPBs as well as short runs of VT with similar QRS morphology as that of the first beat of VF were founded preceding 50 episodes of VF. The initial beat with R-on-T was found in 48 out of 60 episodes of VF. The location of first beat of VF could be identified in 42 episodes, 18 from the sites compatible to the location of right papillary muscle, 6 from right ventricular outflow tract, 11 from left anterior papillary muscle, 7 from left posterior papillary muscle. Nine patients had more than 2 episodes of VF, 7 of them had 2 to 5 distinct QRS morphology. The VPB, VT with different QRS morphology from that of initial beat of VF were found in 22 patients. Conclusions The initial beat of VF had common QRS morphology and origin with part of VPB or VT. The location

关 键 词：心室颤动 室速 QRS 室早 乳头肌 动态心电图 终止 形态 节律 起源 

分 类 号：R541.7[医药卫生—心血管疾病]