起源于三尖瓣环的特发性室性心律失常体表心电图特点及射频导管消融治疗  

Electrocardiographic characteristics and radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the tricuspid annulus

作　　者：张劲林[1] 苏晞[1] 韩宏伟[1] 李振[1] 唐成[1] 蒋萍[1] 程光辉[1] 

机构地区：[1]武汉亚洲心脏病医院心内科,430022

出　　处：《中华心律失常学杂志》2008年第1期12-14,共3页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的评估起源于三尖瓣环的室性心动过速（室速）和室性早搏（室早）的体表心电图特点及射频导管消融治疗效果。方法共12例特发性室速／室早患者接受常规电生理检查及射频导管消融治疗，对所有病例的12导联体表心电图进行分析。结果12例室速／室早均消融成功，并证实均起源于三尖瓣环附近，7例起源于三尖瓣环游离壁侧，5例起源于三尖瓣环间隔侧。三尖瓣环游离壁侧室速／室早QRS波平均时限长于三尖瓣环间隔侧室速／室早；游离壁侧室速／室早比间隔侧室速／室早QRS终末部更多见切迹。间隔侧室速／室早比游离壁侧室速／室早V1导联更多见QS型。结论起源于三尖瓣环的室速／室早是特发性室速／室早的一个亚组，射频导管消融治疗可取得良好效果，掌握其体表心电图特点有助于消融术前判定室速／室早具体起源部位。Objective To evaluate the electrocardiographic （ECG） characteristics and the results of radiofrequency catheter ablation （ RFCA ） of idiopathic ventricular tachycardia （VT） or premature ventricular contraction（PVC） originating from the tricuspid annulus. Methods Twelve patients with idiopathic VT/PVC underwent conventional electrophysiological study and RFCA. The 12 leads ECG characteristics were analyzed. Results The VT/PVCs were proved to originate from the tricuspid annulus and were successfully eliminated by RFCA in all cases. Seven VT/PVCs originated from the free wall of the tricuspid annulus and the remaining 5 from septal portion of the tricuspid annulus. QRS duration was greater in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septal portion（ P 〈 0.01 ）. ＂Notching＂ of the QRS complex was observed more often in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus. A QS wave in lead V1 was observed more often in VT/PVCs arising from the septum of the tricuspid annulus than those from the free wall of the tricuspid annulus. Conclusion Tricuspid annular VT/ PVC is a distinct subgroup of idiopathic VT/PVC and can be successfully treated by RFCA. The detailed origin of these VT/PVCs can be determined by 12-lead ECG analysis.

关 键 词：室性心动过速 室性早搏 心电图 射频导管消融 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]