左心室流出道不同部位室性心律失常的心电图特征及射频消融治疗  

Electrocardiogram characteristics of ventricular arrhythmias originating from left ventricular outflow tract and radiofrequency catheter ablation

作　　者：陈光毅[1] 林佳选[1] 季亢挺[1] 李嘉[1] 殷日鹏[1] 李岳春[1] 李进[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》2016年第2期140-144,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：温州市重大科研项目（Y20080086）

摘　　要：目的探讨左心室流出道（LVOT）不同部位起源的室性心律失常（VA）的心电图特征及射频消融方法。方法研究纳入2006年7月至2015年8月于温州医科大学附属第二医院心内科行射频消融治疗的163例LVOT室性早搏（PVC）／室性心动过速（VT）患者。根据标测及消融结果分为4个亚组：左冠窦（LCC）组、右冠窦（RCC）组、左冠窦下的左纤维三角（ILCC）组和左右冠窦交界（L-RCC）组。选取同时期经导管射频消融治疗的163例右心室流出道（RVOT）PVC／VT患者对比分析，比较RVOT与LVOT及其不同部位PVC／VT的心电图特征并进一步提出鉴别流程。结果LVOT组射频消融成功156例（95．71％），失败7例。4个亚组在激动顺序标测有效靶点心室电位领先程度、手术时间、X线曝光时间、放电时间均差异无统计学意义（P〉0．05）。LVOT组亚组分析显示：①起源于RCC及L-RCC的VA，79．49％患者Ⅰ导联以正向波为主，呈现R、r或m型；LCC组13．04％呈现正向波；ILCC组均不呈现正向波（P〈0．01）。②各亚组在下壁导联及V4～V6导联均呈R型，在aVR、aVL导联均呈Qs型。但R波高度及Qs波深度的分布特征不同：RCC组和L-RCC组92．31％表现为RⅡ〉RⅢ、QSaVR〉QSavL，LCC组和ILCC组79．03％表现为RⅡ〈RⅢ和QSaVR〈QSaVL。③ILCC组71．88％患者V1导联以正相波为主，呈R型；LCC组（57．61％）及RCC组（76．67％）则以负相波为主，呈rs型；L-RCC组在V1导联呈qrS或Qs型伴下降支切迹为其特征性心电图表现。④ILCC组胸前导联移行多数在V1之前，而LCC、RCC及L-RCC组大部分在V2～V3。⑤ILCC组下壁导联R波降支常有切迹（87．50％），而另3组仅2例有R波降支切迹（1．53％）。结论LVOT起源PVC／VT并非罕见，多数经主动脉逆行途径采用常规标测技术普通温控消融导管进行标测与消融安全有效。其不同起源的体表12导联心电图亦有些不同Objective This study was aimed to investigate the mapping, surface electrocardiogram （ECG） characteristics and ablation strategies of ventricular arrhythmias （VA） originating from left ventricular outflow tract （LVOT）. Methods From July 2006 to August 2015,163 LVOT VA patients, who underwent the radiofrequency catheter ablation （RFCA） in the Second Affiliated Hospital of Wenzhou Medical University were selected. Based on the mapped and ablated areas, all patients were divided into four subgroups：left coronary cusp （LCC） ,fight coronary cusp （RCC） ,inferior left coronary cusp （ILCC） ,junction of left coronary cusp and right coronary cusp （L-RCC）. Another 163 patients were selected as control group,which the VA were origina- ting from right ventricular outflow tract （RVOT）. The electrocardiographic characteristics of PVC/VT were compared between the two groups. Results One hundred and fifty-six （ 95.71%） patients underwent the suc- cessful RFCA.1＂here was no significant difference in leading potential,exposure time and ablation time between the four subgroups（P 〉0. 05）. The characteristics of surface 12-lead ECG of VA originating from LVOT were as following.①A positive R,r or m morphology in lead Ⅰ was presented in most of RCC and L-RCC cases（79. 49%）, but 13.04% in group LCC and 0 in group ILCC （P〈0.01） .②All cases demonstrated a R morphology in leads Ⅱ,Ⅲ,aVF and V4 -V6, Qs pattern in leads aVL and aVR. However,92. 31% of RCC and L-RCC cases,the amplifi- cation of R wave in lead Ⅱ is was higher than lead Ⅲ and the depth of QS wave in lead aVR was deeper than lead aVL（RⅡ〉RⅢ ,QSaVR〉QSaVL）,79.03% of LCC and ILCC cases showed RⅡ〈RⅢ, QSaVR 〈QSaVL（ P〈0. 01 ）. ③The 71.88% of patients in group ILCC showed a R morphology in lead V1 ,but 76. 67% of patients in the group RCC, and 57.61% in the group LCC showed a rS morphology in lead V1. The＂qrS＂ or ＂QS＂ wave demonstrated a de- scending limb incisura in L-RCC group.�

关 键 词：心电生理 室性心律失常 左心室流出道 导管消融射频 

分 类 号：R541.7[医药卫生—心血管疾病]