起源于左心室流出道的早搏经右心室流出道优先传导  

Preferential conduction of arrhythmias originating from the left ventricular outflow tract to right ven- tricular outflow tract

作　　者：李进[1] 郑程[1] 李岳春[1] 李嘉[1] 林佳选[1] 林加锋[1] 

机构地区：[1]温州医科大学附属第二医院&育英儿童医院心内科,325027

出　　处：《中华心律失常学杂志》2015年第5期388-392,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：温州市科技计划项目（Y20140495）

摘　　要：目的探讨起源于左心室流出道（LVOT）的特发性室性早搏（PVCs）经右心室流出道（RVOT）优先传导的电生理现象及其射频消融治疗的效果与安全性。方法对2010年10月至2014年10月在温州医科大学附属第二医院心内科接受经导管射频消融治疗PVCs和／或特发性室性心动过速（IVT）731例进行观察，最终入选14例特发性心室流出道起源的PVCs（男8例），年龄31～58（48．0±11．3）岁，病程8～36（23．4±12．6）个月。所有患者完成标测与消融，分析其消融过程中体表心电图特征及腔内电图的变化规律。结果14例均消融成功（成功率100％），无并发症发生。根据X线影像及三维标测定位，本组患者有以下共同特征：①入院时心电图多数符合RVOT起源PVCs的特征；②经RVOT标测与消融后，多数患者V1～V2导联R波振幅指数由〈30％变为〉30％，或时限指数由〈50％变为〉50％，符合LVOT起源PVCs的心电图特征；③激动标测的最早心室激动时间（EVA）RVOT迟于LVOT；④起搏标测的s-R间期（起搏标测时刺激信号与起搏产生的QRS波起始之间的时限），RVOT起搏时明显短于LVOT起搏；⑤RVOT起搏表现为经RVOT突破的PVCs心电图特征，而LVOT起搏表现为经LVOT突破的PVCs心电图特征；⑥最后消融成功的靶点均在LVOT。结论LVOT起源PVCs存在经RV0T优先传导现象，术中心电图演变有一定规律，掌握这些规律有助于初步判定其起源部位，缩短消融术时间。Objective To explore the eletrophysiological phenomenon of preferential conduction of premature ventrieular contractions （PVCs）originating from the left ventricular outflow tract （LVOT）to right ven- tricular outflow tract（RVOT） ,and observe the curative efficacy and safety of radiofrequency catheter ablation （RFCA） on this kind of ventricular arrhythmias. Methods We selected 731 patients with PVCs who visited The Second Affiliated Hospital ＆ Yuying Children＇s Hospital of Wenzhou Medical University from Otcober 2010 to Otcober 2014. Electrocardiographic morphology indicating that arrhythmias may originate from RVOT in 14 patients （8 males, average age of 48.0±11.3 years old） undergoing RFCA, observing their intracardiac electro- cardiographic characteristics and variations during the procedure of mapping and ablation. Results All these patients （ 100% ） were successfully ablated without related complications. According to the X-ray image and three-dimensional mapping systems to locate target site,we found some common characteristics of these patients.①All patients showed left bundle branch block morphology. ②During mapping and ablating in RVOT,the R/S- wave amplitude index in V1-V2 leads gradually turned from 〈30% to〉30% with the R-wave duration index turned from 〈50% to 〉50% ,which was in accord to the characteristics of PVCs originating from LVOT. ③Ac- tivation mapping showed the early ventricular activation （EVA） in the RVOT later than in LVOT. ④The inter- val of the pacing stimulus to the onset of the QRS （St-QRS） from the RVOT was shorter than that from the LV- OT during pace mapping. ⑤The breakout site showed the electrocardiographic characteristics of RVOT when pacing from the RVOT, and the breakout site showed the electrocardiographic characteristics of LOVT when pa- cing from the LVOT. ⑥All the successful ablations were achieved in the LVOT. Conclusion The phenomenon of preferential conduction in PVCs originating from the LVOT to RVOT was confirmed

关 键 词：室性早搏 优先传导 心电图 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]