起源于右室流出道和三尖瓣环交界区的室性早搏的心电图特点和消融治疗  

Electrocardiographic characteristics of idiopathic premature ventricular contractions originating from the junction of the right ventricular outflow tract and tricuspid annulus

作　　者：鲁志兵[1] 何勃[1] 何文博[1] 谢菁[1] 余小梅[1] 江洪[1] 

机构地区：[1]武汉大学人民医院心内科武汉大学心血管病研究所心血管病湖北省重点实验室,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2017年第4期316-321,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的报道起源于右室流出道和三尖瓣环交界区(RTJ)的室性早搏(简称室早)的心电图特点和射频消融疗效。方法回顾性分析右室消融成功的室早的心电图和腔内电生理特点。根据室早起源部位分为右室流出道(RVOT)组,三尖瓣环(TV)组,RVOT与TV之间的区域(RTJ)组。另选5例无室早的阵发性室上性心动过速患者作为对照组。结果 RVOT组有78例,TV组有11例,RTJ组有12例。RTJ组的室早心电图在Ⅰ、Ⅱ、Ⅲ和aVF导联均为单相R波,aVL导联均为低平波形,rsr′、qs、qr、rs或r型,平均振幅为(0.3±0.1)mV,而RVOT组的室早aVL导联为深倒的S波,平均振幅为(-0.7±0.4)mV;TV组的室早aVL导联为直立的R波,平均振幅为(0.8±0.3mV)(P<0.05)。应用激动标测和起搏标测能成功定位RTJ室早并成功消融。5例对照组患者RTJ起搏在aVL导联产生低平QRS波形。结论 RTJ起源的室早并不少见,心电图aVL导联低平是区别于RVOT或TV起源室早的显著特点。射频消融治疗安全有效。Objective To report the electrophysiological characteristics of a subgroup of idiopathic PVCs origina ting from the junction of right ventricular outflow tracttricuspid valve annulus （RVOT TV）. Methods Surface ECG and intra-cardiac electrophysiological characteristics were analyzed in 101 patients with frequent PVCs who un derwent successful radiofrequency catheter ablation （RFCA） in the right ventricle. According to the origin of PVCs were divided into right ventrieular outflow tract （RVOT） group, three tricuspid annulus （TV） group, between the RVOT and the TV region （RTJ） group. Pacing was performed in the right ventricle in another 5 control subjects. Result There were 78 cases in RVOT group, 11 cases in group TV and 12 cases in group RTJ. The PVCs origina- ting from RVOT-TA junction showed a monophonic R morphology in leads I , II , III and aVF and a flat QRS corn plex in lead aVL. A flat QRS complex Ersrr, qs,qr, rs or r pattern, mean r or qs amplitude, （0.3±0.1） mV] in lead aVL distinguished the RVOT-TA junction origin from the RVOT [deep negative, （0.7 ± 0.4） mV] and the TA Etall positive, （0.8±0.3） mV] origins. Activation mapping and pace mapping strategies were successfully applied to localize this specific origin of the PVCs. Pacing at the RVOT-TV junction in the control subjects validated a flat QRS complex in lead aVL. Conclusion The RVOT-TV junction is a non-rare but distinct origin of right ventricular PVCs. The flat QRS corn plex in lead aVL distinguishes this origin from RVOT and TA. RFCA is highly effective for eliminating PVCs in this origin.

关 键 词：电生理学 右室流出道 三尖瓣环交界区 室性早搏 射频消融 

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