儿童致心律失常性右室心肌病14例心电学分析  

Electrocardiographic features of arrhythmogenic right ventricular dysplasia in children

作　　者：王树水[1] 梁东坡[1] 蒋秋平[1] 徐衍梅[1] 张智伟[1] 李渝芬[1] 钱明阳[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院心儿科,广州510080

出　　处：《中国实用儿科杂志》2009年第9期690-693,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的总结儿童致心律失常性右室心肌病(ARVC/D)的心电学特点。方法2003年7月至2008年12月广东省心血管病研究所共收治儿童ARVC/D14例。所有病例均予以12导联体表心电图及24h动态心电图检查。8例进行Fontaine双极导联心电图检查,2例行心内电生理检查及射频消融术。结果14例中9例室早或室速为单形性左束支阻滞型,4例为多形性左束支传导阻滞型,1例为右束支传导阻滞型及左束支传导阻滞型。10例心电图检出Epsilon波。12例QRS波时限(V1+V2+V3)/(V4+V5+V6)≥1.2。13例V1、V2或V3QRS波时限较V6QRS波时限≥25ms。结论左束支传导阻滞型室早及室速、Epsilon波及右胸导联QRS波时限增宽是儿童ARVC/D较常见的心电学改变。Fontaine双极导联心电图简单易行,能够有效地提高Epsilon波的检出率,怀疑ARVD的患儿均应常规进行该项检查。Objective To summarize the electrocardiographic features of arrhythmogenic right ventricular cardiomyopathy/dysplasia （ARVC/D） in children. Methods A total of 14 children （7 females, 7 males） with ARVC/D were involved in this study. All cases underwent 12-lead electrocardiography and hoher examinations. Eight cases received Fontaine modified limb leads electrocardiography technique and 2 patients underwent cardiac electrophysiologic study. Results All these 14 cases were diagnosed with ARVC/D. The premature ventricular extrasystoles or paroxysmal ventricular tachyeardia with left bundle branch block morphology were detected in 13 cases, with monomorphic ventricular extrasystole in 9 eases and polymorphous in 4 cases. One case had both left bundle branch block pattern and right bundle branch block pattern premature ventricular extrasystoles. Epsilon waves were discriminated in 10 cases. A ratio of the QRS duration in leads V1＋V2＋V3/V4 ＋V5 ＋V6 ≥1.2 were observed in 12 cases and parietal block existed in 13 patients. Conclusion The premature ventricular extrasystoles or ventricular tachycardia with left bundle branch block pattern, Epsilon waves, and prolonged localized QRS duration of right precordial leads are the frequent ECG findings in children with ARVC/D. Fontaine modified limb leads electrocardiographic technique is effective in detecting the Epsilon wave and should be used in all ARVC/D patients.

关 键 词：致心律失常性右室心肌病 心电图描记术 室性心动过速 

分 类 号：R72[医药卫生—儿科]