起源于左后分支的室性早搏临床心电图特点和射频消融治疗  

Radiofrequency catheter ablation and electrocardiogram characteristic of the monomorphic prematureventricular contractions originating from the left posterior fascicular

作　　者：韦伟 赵英杰 刘霄燕 贾玉和 王靖 毛克修 楚建民 张澍 

机构地区：[1]中国医学科学院心血管病研究所协和医学院阜外心血管病医院心律失常中心,北京100037

出　　处：《中华心律失常学杂志》2011年第3期214-217,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的报道起源于左后分支的室胜早搏（PVC）的临床心电图特点及射频消融经验。方法8例无器质性心脏病且频发PVC的患者（男5例，女3例），其中5例伴有阵发性左心室室性心动过速（室速），年龄19—54（42．7±10．6）岁。其中3例患者行常规射频导管消融治疗，5例在三维电解剖标测系统（Carto系统）指导下行射频消融治疗。在左后分支标测到最早心室激动点处给予温度控制下射频导管消融。结果8例患者术前均以体表心电图定位起源于左后分支处区域，其PVC或左心室室速的体表心电图均为典型特发性左心室室速（ILVT）表现（QRS波呈右束支阻滞图形，心电轴左偏，QRS时限≤160ms）。其中，QRS波I导联6例呈rS，2例呈Rs；aVL导联呈qR；II、Ⅲ、aVF导联呈rs。胸前导联多在V，～V，处移形，由R转为Rs或rs。在消融成功部位（最早激动点）消融导管均记录到融合有浦肯野电位（PP）的V波，V波提前于体表心电图QRS波时限20—48（33．0±10．2）ms，8例患者行射频消融即时成功。术后3～15（8．1±4．2）个月复查，8例患者动态心电图的PVC均小于10000／24h。所有患者术中、术后无并发症发生。结论起源于左后分支处的PVC，在消融导管标测到PVC最早激动点并融合有PP时可成功消融PVC。Objective To report radiofrequency catheter ablation and electrocardiogram characteristic of premature ventricular contractions （PVC）originating from the left posterior fascieular without structural heart disease. Methods Eight consecutive （5 male,3 female）patients who underwent ablation for frequent PVCs and paroxysmal idiopathic left ventricular tachycardia（ILVT） by conventional catheter or 3-dimensional electroanatomic mapping were enrolled. The earliest ventricular activation was recorded as the site of catheter ablation. All patients were reviewed for ECG and 24 h-halter after ablation therapy at 3,6,12 and 15 months. Results Eight patients were diagnosed as PVC originating form left posterior fascicular by ECG, and 5 patients were confirmed with 3-dimensional electroanatomic mapping. Most of the PVCs showed a RBBB morphology and left axis devia- tion,QRS durations〈 160 ms. In lead 1,6 patients showed rS, and 2 patients showed Rs;qR in lead aVL,rS in lead Ⅱ , Ⅲ ,aVF. The early precordial transition was common at Vl - V3 , R into RS or rS. The earliest site of ventricular activation was recorded with PP and successful ablation. During the follow-up period of 3 - 15 （ 8. 1 ± 4. 2）months after ablation, 8 patients had PVC 〈 1000 beats/24 h without complications. Conclusion The PVCs originating from the left posterior fascicular can successfully ablated in patients without structural heart disease, and the earliest site of ventricular activation was recorded with PP during both sinus rhythm and PVCs.

关 键 词：左后分支 室性早搏 射频导管消融 电解剖标测系统 

分 类 号：R541.7[医药卫生—心血管疾病]