ARVC与RVOT患者窦性心律时心电图的比较  

Comparison of the electrocardiogram features during sinus rhythm between arrhythmogenic right ventricular cardiomyopathy and idiopathic right ventricular outflow tract ventricular tachycardia

作　　者：王立群[1] 汤德欣 苑翠珍[1] 王龙[1] 李鼎[1] 段江波[1] 昃峰[1] 李学斌[1] Wang liqun;Tang dexin;Yuan cuizhen;Wang long;Li ding;Duan jiangbo;Ze feng;Li xuebin(Department of Cardiology,Peking University People’s Hospital,Beijing 100044,China;Department of Cardiology,Longhua District People’s Hospital,Shenzhen,518109,China)

机构地区：[1]北京大学人民医院,100044 [2]广东省深圳市龙华区人民医院,518109

出　　处：《临床心电学杂志》2021年第1期8-11,共4页Journal of Clinical Electrocardiology

摘　　要：目的比较致心律失常右室心肌病(ARVC)和特发性右室流出道室速(RVOT)患者窦性心律心电图特点。方法收集查阅2008至2018年北京大学人民医院诊断为ARVC的21例住院病例以及2008至2011年诊断为RVOT并行射频消融术的31例住院病例,分析比较两组患者术前窦律时常规体表心电图各项参数。结果 (1)ARVC与RVOT两组V1导联QRS时限(QRSd)118.6±23.8ms vs. 98.5±20.6ms,两组V1与V6导联QRSd的差值19.9±8.2ms vs. 10.0±8.6ms,比值1.22±0.11 vs. 1.08±0.096。p值均<0.05;(2)ARVC组右胸导联Epsilon波阳性率,QRS波碎裂阳性率以及QRS波局限性增宽阳性率均显著高于RVOT组。两组右胸导联Epsilon波或QRS波碎裂两者之一阳性者71.4%vs. 16.1%;ARVC和RVOT两组右胸导联Epsilon波或QRS波碎裂或局限性QRS时限增宽三者之一阳性者85.7%vs. 16.1%;(3)ARVC组V1导联QRS波形态57.1%为r Sr(R)形,33.3%呈r S形;RVOT组12.9%为r Sr(R)形,83.9%呈r S形,p<0.001。结论 ARVC组V1导联QRS波时限明显长于RVOT组。Epsilon波与右胸导联QRS波碎裂两者之一阳性的敏感性和特异性均较高;若联合局限性右胸导联QRS波增宽三者之一阳性的敏感性进一步提高,特异性不变。窦性心律的特征性心电图表现有助于鉴别ARVC与RVOT。Objective To compare the ECG features during sinus rhythm between arrhythmogenic right ventricular cardiomyopathy(ARVC) and idiopathic right ventricular outflow tract ventricular tachycardia(RVOT) in China. Methods The ECG features during sinus rhythm before treatment were reviewed in 21 patients diagnosed with ARVC in People’s Hospital of Peking University from 2008 to 2018 and 31 patients diagnosed with idiopathic right ventricular outflow tract ventricular tachycardia(RVOT) who also had radio frequency ablation from 2008 to2011. Results The mean duration of QRS(QRSd) of V1 lead in ARVC group was longer than that of RVOT(118.6±23.8 ms vs. 98.5±20.6 ms, p<0.05). The difference of QRSd between lead V1 and lead I in ARVC was greater than that of RVOT(19.9±8.2 ms vs. 10.0±8.6 ms, p<0.05). The difference of QRSd between lead V1 and lead V6 in ARVC was also greater than that of RVOT(20.5±9.7 ms vs. 7.3±8.2 ms, p<0.05). The ratio of QRSd of lead V1 to lead V6 in ARVC was greater than that of RVOT(1.22±0.11 vs. 1.08±0.096, p<0.05). Right precordial Epsilon waves were presented in 33.3% of ARVC patients, and 3.2% of RVOT patients, p<0.05. Right precordial fragmented QRS were presented in 42.9% of ARVC patients, while 12.9% of RVOT patients,p<0.001. Either right precordial Epsilon waves or fragmented QRS were presented in 71.4% of ARVC patients, while 16.1% of RVOT patients, p<0.001. Localized right precordial QRS prolongation was presented in 61.9% of ARVC patients, while 12.9% of RVOT patients, p<0.001.85.7% of the ARVC patients were positive with one of the above three presentation of the right precordial abnormal features, while 16.1% of RVOT patients, p<0.001. The morphology of QRS of lead V1 was different between two group.57.1% of ARVC patients presented r Sr(R) type, 33.3% presented r S type;while 83.9% of RVOT patients presented r S type, 12.9% presented r Sr(R) type. Conclusions Patients with right precordial Epsilon waves or fragmented QRS or localized right precordial QRS prolongation were more freq

关 键 词：致心律失常性右室心肌病 特发右室流出道室速 体表心电图 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]