起源于主动脉窦频发室性期前收缩的心电生理特征及射频消融治疗  

Electrocardiophysiological characteristics and radiofrequency catheter ablation of frequent premature ventricular contractions originating from aortic sinus of Valsalva

作　　者：陈丽华[1] 卫展扬[1] 黄虔[1] 李大强[1] 熊斌[1] 

机构地区：[1]东莞市人民医院,广东东莞523000

出　　处：《岭南心血管病杂志》2012年第2期151-155,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的报道11例起源于主动脉窦的频发室性期前收缩(premature ventricular contraction,PVC)患者的心电生理特征、射频消融(radiofrequency catheter ablation,RFCA)方法及疗效。方法分析患者术前体表心电图和动态心电图PVC的特点,测量V1或V2导联r波时限和振幅,计算r波与QRS波时限的比值及r波于S波振幅的比值。术中行主动脉窦内激动标测和起搏标测确定PVC起源部位,并行冠状动脉造影辅助定位后行RFCA。结果11例均有频发PVC,5例有反复短阵室性心动过速。下壁导联QRS波呈R形且高大直立,V1导联呈rS型,胸前导联多移行于V3以前,V6导联多呈Rs型或无S波。V1导联r波时限(84.6±9.8)ms,占QRS波时限的50%以上;r/S振幅比值0.72±0.31。有效消融靶点局部电图V波较体表心电图的QRS波明显提前(35.6±8.9)ms,有效靶点放电2～8 s见PVC减少至消失。结论起源于主动脉窦的PVC其下壁导联QRS波呈R形且高大直立,V1或V2导联r波时限宽(>50%同导联QRS波),r波振幅高(>30%同导联S波);主动脉窦内PVC的射频消融治疗是安全、有效的。Objectives To report the electrocardiophysiological characteristics of frequent premature ventricular contractions（PVCs） originating from the aortic sinus of Valsalva in 11 patients,radiofrequency catheter ablation（RFCA） and its effect.Methods Morphologic characteristics of PVCs in electrocardiography（ECG） and Holter of 11 patients were observed before ablation.Duration and amplitude of r wave in lead V1 were measured.Duration ratio of r/QRS and amplitude ratio of r/S were calculated respectively.The origin of PVC was determined by pace mapping and activation mapping at the aortic sinus of Valsalva during the operation with coronary arteriography to assist mapping.RFCA was performed afterwards.Results All of the 11 patients had frequent PVCs and 5 of them had recurrent paroxysmal ventricular tachycardias.QRS in leadsⅡ,Ⅲ and aVF showed tall R waves.QRS in lead V1 presented in the shape of rS and precordial leads transferred before lead V3.QRS complex in lead V6 presented more in the shape of Rs or a non-S wave.Duration of r wave in lead V1 was（84.6±9.8） ms,which exceeded 50% of the QRS complex.Amplitude ratio of r/S was 0.72±0.31.The local ventricular electrogram at effective target ablation was recorded（35.6±8.9） ms prior to QRS on electrocardiogram.PVCs were decreased and eliminated after delivering radiofrequency energy for 2-8 seconds at the target site.Conclusions QRS in leads Ⅱ,Ⅲ and aVF of PVCs originating from aortic sinus of Valsalva showed tall R waves with a wide duration（50% of QRS complex） and tall amplitude（30% of S wave） of r waves in lead V1.Radiofrequency catheter ablation of PVCs at aortic sinus of Valsalva is safe and effective.

关 键 词：心律失常 频发室性期前收缩 主动脉窦 导管消融术 射频电流 

分 类 号：R541.7[医药卫生—心血管疾病]