两例主动脉窦起源室性早搏/心动过速的心电图特点及导管消融治疗研究  

Electrocardiographic characteristics and catheter ablation of two patients with premature ventricular contractions/ventricular tachycardia arising from the aortic sinus of valsalva

作　　者：陈卉[1] 凌智瑜[1] 杜华安[1] 刘增长[1] 殷跃辉[1] 苏立[1] 

机构地区：[1]重庆医科大学附属第二医院心血管内科,重庆400010

出　　处：《重庆医学》2016年第23期3223-3225,3228,共4页Chongqing medicine

摘　　要：目的 探讨主动脉窦起源室性早搏/心动过速的体表心电图特点及导管消融策略。方法 选择两例经心内电生理检查证实分别起源于左冠状动脉窦及右冠状动脉窦的室性早搏/心动过速病例,分析其体表心电图特点,并进行心内电生理检查及导管消融治疗。结果 两例患者室性早搏/心动过速时体表心电图Ⅱ、Ⅲ、aVF导联均呈高大的R波型,aVR导联呈QS型,V1导联R波时限指数均大于或等于50%、波幅指数均大于或等于30%。其中,起源于左冠状动脉窦者Ⅰ导联呈rS型,aVL呈QS型,胸前导联移行位于V2~3;起源于右冠状动脉窦者Ⅰ导联呈Rs型。两例患者均成功消融,无并发症,随访12月无复发。结论起源于主动脉窦的室性早搏/心动过速体表心电图具有特征性的表现,导管消融主动脉窦内室性早搏/心动过速安全、有效。Objective To investigate the surface electrocardiographic characteristics and catheter ablation strategies for pre mature ventricular contractions （PVCs）/ventricular tachycardia （VT） originating from the aortic sinus cusps （ASCs）. Methods Twelve-lead electrocardiographic analysis, electrophysiologic study and catheter ablation were performed in 2 patients with PVCs / VT which successfully eliminated from left ASCs and right ASCs respectively. Results The surface electrocardio- graphic analysis revealed large R wave on lead It , Ill and aVF,QS pattern in lead aVR,the precordial R wave transition at lead V2 or between lead V2 and V3,the indexes of R-wave duration and R/S-wave amplitude ≥50% and ≥30% respectively. In case one the successful ablation target located in left ASCs,the surface electrocardiography（ECG） revealed rS wave in lead I ,QS pattern in lead aVL and precordial R wave transition was between lead V2- 3. In case two the successful ablation target located in right ASCs,the surface ECG showed Rs pattern in lead I. Both patients received catheter ablation without any complication and recur- rence during 12 months of follow-up. Conclusion PVCs / VT originating from ASCs have specific electrocardiographic characteris- tics,catheter ablation is safe and effective in treatment of PVCs/VT originating from the ASCs.

关 键 词：心动过速 室性 VALSALVA窦 室性早搏复合征 主动脉窦 导管消融 心电图 

分 类 号：R541.7[医药卫生—心血管疾病]