经主动脉窦消融成功的室性心律失常体表心电图特点  

Radiofrequency ablation of ventricular arrhythmia originated from the aortic sinus cusp

作　　者：王帆[1] 田杰[1] 李小宁[1] 王明杰[1] 李树岩[1] 

机构地区：[1]吉林大学第一医院心内科,吉林长春130021

出　　处：《中国心脏起搏与心电生理杂志》2017年第2期135-140,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的分析经主动脉窦消融成功的室性心律失常体表心电图特点。方法 36例频发室性早搏/非持续性室性心动过速(PVCs/NSVT)的患者经主动脉逆行途径,在CARTO三维电解剖标测指导下,在主动脉根部-左室流出道衔接部进行三维解剖重建、激动顺序标测和指导消融,且消融成功(1例部分成功),并分析其体表心电图特点。结果 36例患者,经左冠窦消融成功30例(83.3%),右冠窦6例(16.7%)。PVCs在体表心电图均表现心电轴下偏的反复单一形态的QRS波形。经左冠窦消融成功的PVCs/NSVT,Ⅰ导联为R、Rs、rS、r、q或rsr波,Ⅱ、Ⅲ、aVF导联均为高振幅R波,胸前导联PVCs R波移行区位于V_1~V_3导联,且PVCs移行区均早于窦性心律移行区,V_1导联表现为R、Rs、RS、rS或qr波,V_1或V_2导联R/S波幅指数2.64±2.03,R波时限指数0.62±0.12,Ⅲ导联与Ⅱ导联R波振幅比(RⅢ/RⅡ)1.09±0.18,aVL导联与aVR导联QS波振幅比(QSaVL/QSaVR)1.32±0.46。经右冠窦消融成功的PVCs/NSVT,Ⅰ导联为R、Rs、r波,Ⅱ、Ⅲ、aVF导联均为高振幅R波,胸前导联PVCs R波移行区位于V_1~V_3导联,V_1导联表现为R、Rs、rS波,V_1或V_2导联R/S波幅指数0.51±0.38,R波时限指数0.55±0.26,RⅢ/RⅡ0.95±0.23,QSaVL/QSaVR1.12±0.39。PVCs经左冠窦消融成功的V_1或V_2导联R/S波幅指数要高于右冠窦(P<0.05)。结论经左冠窦消融成功的室性心律失常多于右冠窦。体表心电图的相关特征有助于决策主动脉窦内的室性心律失常的具体消融部位。Objective To examine surface electrocardiogram features of ventricular arrhythmias originating from the aortic sinus cusp. Methods Thirty-six consecutive patients with premature ventricular contractions or non-sus- tained tachycardia （PVCs/NSVT） were performed mapping of the excitatory sequence of aortic sinus of Valsalva and left ventricular outflow tract and ablated successfully （one case was partial success） via retrograde transaortic approach guided by CARTO 3-dimensional mapping system. We analyzed surface electrocardiogram features of PVCs/NSVT mentioned above. Results Thirty-six patients with PVCs/NSVT were performed successful ablation which confirm their origination. 30 （83.3 %） patients with left coronary cusp（LCC） origin was found, and 6 （16. 7%） with right coronary cusp （RCC） origin. The QRS features of PVCs/NSVT showed repetitive monomorphic morphology with an inferior axis in surface electrocardiogram. PVCs/NSVT with LCC origination had the following characteristics., a low amplitude ＇R＇ ＇Rs＇ ＇rS＇ ＇r＇ ＇q＇ or ＇rsr＇ pattern in lead I , a high amplitude ＇R＇ pattern in lead Ⅱ , Ⅲ , aVF, the transition zone of precordial R wave was shown in lead V1-V3 prior to the sinus rhythm. A ＇R＇ ＇Rs＇ ＇RS＇ ＇rS＇ or ＇qr＇ pattern was shown in lead V1. The indexes of R wave duration and R/S wave amplitude were 0. 62±0.12 and 2.64 ±2.03.The ratio of the R-wave amplitude between leads Ⅲ and Ⅱ （RⅢ/RⅡ ）was 1.09 ± 0.18. The ratio of QS-wave amplitude between leads aVL and aVR（QSaVL/QSaVR）was 1.32±0.46. Compared with LCC, the main characteristics of PVCs/NSVT with RCC origin： a ＇R＇ ＇Rs＇ or ＇r＇ pattern in lead I , a high amplitude ＇Rpattern in lead Ⅱ ,Ⅲ , aVF, a ＇R＇ ＇Rs＇ or ＇rS＇ in lead V1 and the transition zone of precordial R wave was shown in lead V1-V3. The indexes of R wave duration and R/S wave amplitude were 0.5 5 ± 0.2 6 and 0.51± 0.3 8.（RⅢ/RⅡ ）was 0.95±0.23. （QSavL/QS,vR） was 1

关 键 词：心血管病学 主动脉窦 CARTO三维电解剖 电生理 射频消融 室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]