起源于左冠状动脉窦及右冠状动脉窦的室性早搏心电图特征分析及射频消融治疗  

Electrocardiographic characteristics and radiofrequency catheter ablation of premature ventricular contractions originating from left and right coronary cusp

作　　者：谭红伟[1] 张旭敏[1] 邹誉[1] 周建[1] 李莹[1] 邱建平[1] 刘学波[1] 

机构地区：[1]同济大学附属东方医院心内科,上海200120

出　　处：《国际心血管病杂志》2016年第3期172-175,182,共5页International Journal of Cardiovascular Disease

摘　　要：目的：比较左冠状动脉窦及右冠状动脉窦起源的室性早搏（室早）心电图特征。方法：入选成功行主动脉根部室早消融的患者20例,按消融部位分为左冠状动脉窦室早组（LCC组）15例、右冠状动脉窦室早组（RCC组）5例,比较两组心电图特征。结果：RCC组患者Ⅰ导联均为R波;LCC组患者Ⅰ导联4例为QS波,10例为RS或rs波,1例为R波（χ^2=16.80,P〈0.01）。与RCC组比较,LCC组患者Ⅲ导联R波振幅增高[（2.01±0.45）mV对（1.45±0.33）mV,P〈0.05]、aVL导联QS波振幅加深[（1.20±0.24）mV对（0.65±0.21）mV,P〈0.01]、R波振幅Ⅲ/Ⅱ比值及QS波振幅aVL/aVR比值增大（1.09±0.12对0.80±0.12,P〈0.001;1.31±0.35对0.60±0.24,P〈0.001）、Ⅰ导联QRS波时限缩短[（78±32）ms对（120±13）ms,P〈0.05]、aVL导联QRS波时限延长[（128±14）ms对（100±24）ms,P〈0.05]。除1例患者因起源点临近左冠状动脉开口而放弃消融外,其余均消融成功。平均随访（13±6）个月,无复发病例及并发症。结论：对于体表心电图提示室早起源于左室流出道的患者,Ⅰ导联R波提示RCC室早,Ⅰ导联RS或rs波提示LCC室早;与RCC室早相比,LCC室早Ⅲ导联R波振幅较高、aVL导联QS波振幅较大、R波振幅Ⅲ/Ⅱ比值及QS波振幅aVL/aVR比值增大。Objective：This study was undertaken to compare the electrocardiography characteristics of premature ventricular contractions（PVCs）from left coronary cusp（LCC）and right coronary cusp RCC. Methods：We studied 20 consecutive patients who underwent successful catheter ablation for PVCs originating from LCC（n=15）and RCC（n=5）.Characteristics of 12-lead ECG were analyzed. Results：All patients with RCC PVCs presented R morphology in lead Ⅰ,whereas in patients with LCC PVCs,4 presented QS morphology,10 presented RS or rs and 1 presented R morphology（P〈0.01）.The R wave amplitude in leadⅢ were significantly higher[（2.01±0.45）mV vs.（1.45±0.33）mV,P〈0.05]and the Q wave amplitude in aVL were significantly deeper[（1.20± 0.24）mV vs.（0.65± 0.21）mV,P〈0.01]in patients with LCC PVCs than that in patients with RCC PVCs.Compared with RCC PVCs,the Ⅲ/Ⅱ ratio of R wave amplitude and aVL/aVR ratio of QS wave amplitude were significantly larger in patients with LCC PVCs（1.09± 0.12 vs.0.80± 0.12;1.31±0.35 vs.0.60±0.24,both P〈0.001）.The QRS duration was significantly shorter in lead I[（78±32）ms vs.（120± 13）ms,P〈0.05]and longer in lead aVL [（128±14）ms vs.（100±24）ms,P〈0.05]in patients with LCC PVCs than that in patients with RCC PVCs.The ablation procedures succeeded in all patients except far one whose ablation was not performed because the origin of the PVCs was identified close to the ostium of left coronary artery.There were no major procedural complications.No patient developed PVCs recurrence during a mean follow-up of（13 ± 6）months. Conclusion：In patients with left ventricular out-flow tract PVCs,a relatively large R wave in lead Ⅰ is seen in RCC PVCs while RS or rs wave in leadⅠ seen in LCC PCVCs.LCC PVCs shows higher R wave in leadⅢ,deeper Q wave in aVL,higher Ⅲ/Ⅱ ratio of R wave amplitude and aVL/aVR ratio of QS wave amplitude.

关 键 词：室性早搏 射频消融 主动脉根部 心电图 

分 类 号：R541.7[医药卫生—心血管疾病]