心电图Ⅰ导联m型QRS波形态在流出道室性心律失常中的诊断价值  

The diagnostic value of QRS characteristics for outflow tract ventricular arrhythmia:Type m QRS morphology in lead Ⅰ

作　　者：邸成业[1,2] 万征[3] 丁燕生[4] 林文华[1,2] 

机构地区：[1]天津医科大学心血管病临床学院,天津300457 [2]泰达国际心血管病医院心内一科,天津300457 [3]天津医科大学总医院心血管病中心,天津300052 [4]北京大学第一医院心内科,北京100034

出　　处：《中国心脏起搏与心电生理杂志》2017年第3期215-220,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨心电图Ⅰ导联QRS波形态呈m型在流出道室性心律失常(PVC)中的定位诊断价值。方法回顾性分析成功行射频消融的流出道PVC患者357例,根据消融成功的心腔分为两组:左室流出道(LVOT)消融成功者(A组,n=139),右室流出道(RVOT)消融成功者(B组,n=218),比较两组患者心电图Ⅰ导联QRS波呈m型的例数、Ⅰ导联QRS波的振幅、靶点位置及靶点图电位特点。结果 (1)A组患者9例Ⅰ导联QRS波形态呈m型,B组患者30例Ⅰ导联QRS波形态呈m型,发生率有显著差异(6.5%vs 13.8%,P<0.05)。(2)两组患者Ⅰ导联QRS波振幅有显著差异[(0.38±0.13)mV vs(0.21±0.13)mV,P<0.01];两组患者Ⅰ导联QRS波时程差异无显著性[(129.0±29.4)ms vs(145.6±26.0)ms,P>0.05]。(3)A组消融成功靶点位置位于RCC前部,B组消融成功靶点位置位于RVOT左侧肺动脉瓣附近游离壁、间隔交界处的间隔侧,两者靶点解剖位置相距较近。(4)两组靶点图V波提前QRS波程度有显著差异[(31±12.3)ms vs(21±5.7)ms,P<0.05]。结论流出道PVC的Ⅰ导联QRS波形态呈m型提示消融成功靶点位置在RCC前部,或RVOT左侧肺动脉瓣附近游离壁、间隔交界处的间隔侧,RVOT起源多于LVOT起源,且两者靶点解剖位置相距较近。Objective To investigate the diagnostic value of type ＂m＂ QRS morphology in lead I for ventricular ar- rhythmia. Methods We retrospectively analyzed 357 patients with successful radiofrequency ablation in our hospi- tal. According to the successfully ablated target, the patients were divided into two groups： left ventricular outflow tract （LVOT） group （Group A, n = 139）, right ventricular outflow tract （RVOT） group （Group 13, n = 218）. The case number of type ＂m＂ QRS morphology in lead I, the amplitude of QRS wave in lead I, the target position, and the target potential of the two groups were compared. Results OIn group A, 9 cases with type m QRS morpholo- gy in lead I were recorded; in group B, 30 cases with type m QRS morphology in lead I were recorded, the incidence rate of group B was larger than group A, with statistical difference（6.5% vs 13.8% ,P〈O.05）. OQRS wave ampli- tude in group A was larger than group B in lead I, with statistical difference [（0.38±0.13） mV vs （0.21±0.13） mV, P〈0.01], but there was no statistical difference of QRS wave duration in Lead I between the two groupsE（129.0±29.4） ms vs （145.6±26.0） ms,P〉0.05]. ③The successful ablated target position was located at the anterior side of RCC in group A and that was loca- ted at septal side of the junction between RVOT free wall and septal wall near the pulmonary valve in group B, with close anatomical position between the two groups . The V - QRS interval of group A was smaller than in group A that group B, with statistical difference[ （31±12.3） ms vs （21±5.7） rns,P〈0.05]. Conclusion Type ＂m＂ QRS morphoeogy in lead I in patients with outflow tract ventricular arrhythmia indicates that successful ablation target is at LCC/RCC junction, RCC anterior part, septal side of the junction between RVOT free wall and septal wall near the pulmonary valve. The RVOT origin is more often than LVOT origin, with close anatomical position between the two groups.

关 键 词：心血管病学 心电图 电生理学 室性心律失常 导管消融 射频电流 I导联 

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