起源于右室流出道间隔部特发性室性早搏心电图及心电向量图研究  

Characteristics of electrocardiogram and vectorcardiogram of idiopathic ventricular premature contraction originating from right ventricular outflow tract septum

作　　者：蒋智善 范咏梅[2] 肖春霞[2] Jiang Zhi-shan;Fan Yong-mei;Xiao Chun-xia(Depariment of Function, Mawangdui Hospital Affiliated to University of South China;Mawangdui District of Hu’nan Provincial People’s Hospital, Changsha Hu^an 410000, China)

机构地区：[1]南华大学附属马王堆医院功能科,湖南长沙410000 [2]湖南省人民医院马王堆院区功能科

出　　处：《实用心电学杂志》2016年第3期181-187,共7页Journal of Practical Electrocardiology

基　　金：湖南省医药卫生科研计划项目(B2014-074);湖南省科技计划项目重点研发计划(2015SK2046)

摘　　要：目的探讨经射频消融证实的起源于右室流出道间隔部的特发性室性早搏（室早）的心电图特征及心电向量图特征。方法采用CARDIO-View心电工作站收集并分析14例经射频消融术证实为右室流出道间隔部特发性室早患者的12导联心电图及Frank导联心电向量图参数。结果起源于右室流出道间隔部的特发性室早呈类左束支阻滞图形。12导联心电图胸导联移行指数彡0的有12例（85.7%)，V2导联R波时限指数<50%的14例（100%)，V2导联R/S波振幅指数<30%的有13例（92.9%)，SV2/RV3指数>1.5的有12例（85.7%)。心电向量图特征为：QRS环运行方向在F面呈CW和CCW的各有5例（35.7%)，H面呈CCW的有10例（71.4%)，S面均呈CW(100%);起始0.04s，QRS环振幅逐渐增大，QRS环方位大部分指向左前下;〇.01?〇.04s向左向量逐渐增加，向前向量逐渐减少；QRS环最大向量及大部分面积位于左下后。结论心电图对起源于右室流出道间隔部的室早定位诊断具有较高的准确率。起源于右室流出道间隔部的室早有典型的心电向量特征。Objective To investigate the characteristics of electrocardiogram (ECG) and vectorcardiogram ( VCG) of idiopathic ventricular premature contraction ( IPVC) originating from right ventricular outflow tract septum ( RVOTS) verified by radiofrequency ablation ( RFA). Methods We collected and analyzed the parameters of 12 lead ECG and Frank lead VCG among 14 RVOTS originated IPVC patients verified by RFA with CARDIO-View ECG workstation. Results In 12 lead ECG, RVOTS originated IPVC was shaped like left bundle branch block. There were 12 cases (85.7% ) with precordial transition ratio^O, 14 cases(100% ) with R-wave duration index <50% in lead V2, 13 cases (92. 9% ) with R/S-wave amplitude index <30% in lead V2, and 12 cases(85.7% ) with SV2/RV3 index >1.5. The characteristics of VCG were as follows. In F plane, QRS loop operated in a clockwise( CW) and counter-clockwise( CCW) direction in 5 cases(35.7% ) respectively; in H plane, it operated in CCW direction in 10 cases(71.4% ) ; in S plane, its operating direction was CW in all the cases(100% ) ; at the first 0. 04 s, the amplitude of QRS loop gradually increased, and most of it was oriented leftward, anteriorly and inferiorly ; In the period of 0. 01~ 0. 04 s, leftward vectors gradually increased while anterior ones gradually decreased; the largest vector of QRS loop and the majority of its area was located leftward, inferiorly and backward. Conclusion ECG is proved to have high accuracy in the location and diagnosis of RVOTS originated IPVC. Typical characteristics of VCG are found in RVOTS originated IPVC.

关 键 词：室性早搏 右室流出道 心电图 心电向量图 射频导管消融 

分 类 号：R540.4[医药卫生—心血管疾病]