心脏再同步化治疗左心室起搏心电图的特点  

Electrocardiographic patterns during left ventricular pacing in cardiac resynchronization therapy

作　　者：过瑾 张常莹[1] 承燕[1] 王如兴[1] Guo Jin;Zhang Chang-ying;Cheng Yan;Wang Ru-xing(Department of Cardiac Function,Wuxi People＇s Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214023,China)

机构地区：[1]南京医科大学附属无锡市人民医院心功能科,江苏无锡214023

出　　处：《实用心电学杂志》2018年第3期182-184,188,共4页Journal of Practical Electrocardiology

摘　　要：目的比较不同冠状静脉起搏后左心室(左室)心电图的特点。方法选取心脏再同步化治疗(CRT)患者共43例,按照左室电极植入冠状静脉靶血管分组,分为侧静脉组(7例)、后静脉组(8例)、后侧静脉组(13例)、前侧静脉组(8例)、心中静脉组(7例)。术后使用程控仪程控为单左室起搏模式,记录单左室起搏的12导联心电图,通过测量比较各组左室起搏图形的差异。结果 43例患者中,26例(60.47%)心电轴右偏,共4例电轴左偏仅见于心中静脉组,心中静脉组与其他各组电轴分布比较,差异有统计学意义。Ⅰ导联起始部Q波、Ⅰ导联R/S≤1及V_1导联R/S≥1在所有病例中的出现率分别为79.07%、83.72%和67.44%,而在心中静脉组中出现率仅分别为42.86%、42.86%和28.57%;其中Ⅰ导联R/S≤1的出现率在后侧静脉组明显高于心中静脉组(P=0.007)。下壁导联及V_5、V_6导联主波方向在各组之间差异不大。结论 CRT左室电极植入靶血管不同导致左室起搏的心电图表现有所不同,侧静脉、后静脉、后侧静脉和前侧静脉4组左室起搏图形类似,心中静脉起搏与其他静脉比较,左室起搏心电图图形差异较大。在诊断左室是否起搏时,应格外注意左室电极植入静脉的位置。Objective To compare the electrocardiographic patterns recorded after left ventricular pacing from different coronary veins. Methods We selected 43 patients treated by cardiac resynchronization therapy（ CRT）.According to the target vessel of coronary vein in the implantation of left ventricular electrode,they were divided into five groups： lateral vein group（ 7 patients）,posterior vein group（ 8 patients）,posterolateral vein group（ 13 patients）,great（ anterior） vein group（ 8 patients） and middle cardiac vein group（ 7 patients）. The uni-left-ventricular pacing mode was set by programming controller after CRT. We recorded 12-lead electrocardiograms（ ECGs） during uni-left-ventricular pacing,and measured and compared the ECG patterns among the five groups. Results Among the 43 patients,right axis deviation was observed in 26（ 60. 47%）; 4 cases of left axis deviation were only found in middle cardiac vein group of which the axis distribution significantly varied from other groups. The incidences of Q wave in the initial segment of leadⅠ,R/S≤1 in leadⅠand R/S≥1 in lead V1 were 79. 07%,83. 72% and 67. 44%,respectively while in middle cardiac vein group the incidences were only 42. 86%,42. 86% and 28. 57%,respectively. In posterolateral vein group,the incidence of R/S≤1 in lead Ⅰ was significantly higher than that in middle cardiac vein group（ P = 0. 007）. The QRS morphology patterns in inferior wall leads and lead V5,V6 did not vary significantly among different groups. Conclusion Different electrocardiographic patterns of left ventricular pacingcorrespond to different target vessels in the implantation of left ventricular electrode. The ECG patterns of left ventricular pacing from lateral vein,posterior vein,posterolateral vein and great（ anterior） vein are similar,but the pattern of pacing from middle cardiac vein is quite different from those from other veins. The implantation site of left ventricular electrode should be paid extra attention in the diagnosis of

关 键 词：心脏再同步化治疗 左室电极 左室起搏 起搏心电图 

分 类 号：R318.11[医药卫生—生物医学工程]