射频导管消融治疗的特发性室性心律失常心电图特征分析  

Electrocardiographic characteristics of idiopathic ventricular arrhythmias from different sites

作　　者：林佳选[1] 陈星星[1] 李岳春[1] 季亢挺[1] 殷日鹏[1] 林加锋[1] 

机构地区：[1]温州医科大学附属第二医院心内科,325027

出　　处：《心电与循环》2014年第4期321-325,共5页Journal of Electrocardiology and Circulation

基　　金：温州市重大科研项目(Y2008086)

摘　　要：目的探讨不同起源的特发性室性期前收缩(PVCs)和(或)室性心动过速(VT)的心电图特征,提出鉴别流程。方法根据射频导管消融PVCs/VT有效靶点或心室最早激动点的×线胸片进行定位,分析不同起源PVCs/VT的12导联心电图QRS波群。结果 828例接受导管消融,580例起源于右心室,248例起源于左心室,左、右心室起源者胸导联移行指数<0的分别占97.58%及7.24%;左和右心室流出道起源者下壁导联多数呈R型,V_1上,多数右心室流出道起源者呈rS型,右室间隔起源呈QS型,主动脉瓣上起源者常呈rS或RS型;下壁导联上,左前分支起源者常呈qR型,左后分支起源者常呈rS型。结论结合体表心电图胸导联移行指数、下壁导联和V_1上的QRS波群特征可初步判断特发性PVCs/VT的起源部位。Objective To explore the electrocardiographic （ECG） characteristics of idiopathic premature ventricular complexes （PVC） and ventricular tachycardia （VT） from different origins and put forward a strategy to identify its origins. Methods The effective target site or the earliest ventricular activation site on roentgenogram during radiofrequency ablation was identified as the origin of PVC/VT and the QRS waves of PVC/VT on a 12- lead ECG were analyzed. Results 828 patients underwent ablation for PVC/VT. Of them, 580 cases had PVC/VT originated from right ventricle and 248 from left ventricle. Precordial transition index 〈0 was seen in 97.58% cases with left ventricular origin and 7.24% cases with right ventricular origin. R wave in inferior leads was the most common pattern for PVC / VT from both right （RVOT） and left ventricular outflow tract. In lead V1, most PVC/VT from RVOT showed rS, PVC/VT from right septum showed QS and those from above aortic valve showed rS or RS. In inferior leads, PVC/VT from left anterior fascicular often manifested as qR, those from left posterior fascicular often manifested as rS. Conclusion Combining precordial transition index with QRS patterns in inferior leads and lead V1 on surface ECG may preliminary determine the origins of idiopathic PVCs/VT.

关 键 词：室性期前收缩 特发性室性心动过速 射频导管消融术 心电图 

分 类 号：R541.7[医药卫生—心血管疾病]