三尖瓣环不同部位起源的特发性室性心律失常患者心电图QRS波特征分析  

QRS wave characteristics in electrocardiogram of patients with idiopathic ventricular arrhythmia originating from different parts of tricuspid annulus

作　　者：李艳红 杨亚莉 张博[2] Li Yanhong;Yang Yali;Zhang Bo(Electrocardiographic Room,Xiantao First People’s Hospital Affiliated to Yangtze University,Xiantao 433000,China;Cardiovascular Medicine Department,Xiantao First People’s Hospital Affiliated to Yangtze University,Xiantao 433000,China)

机构地区：[1]长江大学附属仙桃市第一人民医院心电图室,仙桃433000 [2]长江大学附属仙桃市第一人民医院心血管内科,仙桃433000

出　　处：《心脑血管病防治》2021年第3期218-221,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的分析三尖瓣环不同部位起源的特发性室性期前收缩(IPVCs)/特发性室性心动过速(IVT)患者体表12导联心电图QRS波特征及变化规律。方法收集2013年1月至2018年12月仙桃市第一人民医院210例行射频消融术(RA)治疗的三尖瓣环起源的IPVCs/IVT患者的临床资料,分析患者不同起源部位的体表心电图特征和RA的治疗效果。结果本组210例患者中,行RA治疗成功192例,成功率为91.43%。随访3~36个月,平均(19.94±3.24)个月,期间复发6例。将发病部位为前侧壁、侧壁、后侧壁作为游离壁组(99例),前间隔、中间隔、后间隔为间隔组(111例)。相比间隔组,游离壁组QRS平均时限明显增宽差异有统计学意义(t=13.500,P<0.01)。三尖瓣环游离壁各个部位起源的IPVCs/IVT患者在心电图Ⅰ导联的比较,并无统计学意义(χ^(2)=6.876,P>0.05);Ⅰ、aVL导联呈现R型,V_(1)~V_(3)导联呈现rS型,V_(5)~V_(6)导联呈现R型,胸前导联移行区多见于V_(3)导联或之后,下壁导联呈现R型或Rs型或rS型。三尖瓣环间隔部各个部位起源的IPVCs/IVT患者在心电图Ⅰ导联呈现R型,Ⅱ导联呈现Rs型或R型,Ⅲ导联呈现QS型或rS型或Rs型,aVF导联呈现rS型或rs型或R型,V_(1)导联呈现QS型,V_(5)~V_(6)导联呈现R型,胸前导联移行区多见于V_(2)~V_(3)导联之间,或V_(3)导联之后。结论三尖瓣环不同部位起源的IPVCs/IVT患者体表12导联心电图QRS波特征存在一定差异,亦存在一定变化规律,这些心电图特征有助于术前评估其起源部位和有效靶点,有助于减少手术时间,降低RA治疗的失败率。Objective To analyze the characteristics and changes of QRS wave of 12 lead electrocardiogram in patients with idiopathic premature ventricular contractions(IPVCs)/idiopathic ventricular tachycardia(IVT)originating from different parts of tricuspid annulus.Methods The clinical data of 210 patients with IPVCs/IVT originating from tricuspid annulus treated by radiofrequency ablation(RA)was collected,and the characteristics of electrocardiogram in patients with different origin sites and the therapeutic effects of RA were analyzed.Results Among 210 patients in this group,192 were successfully treated with RA,the success rate was 91.43%.The follow-up period ranged from 3 to 36 months,with an average of(19.94±3.24)months,during which 6 cases relapsed.The anterolateral,lateral and posterolateral walls were taken as the free wall group(99 cases),and the anterior,middle and posterior septums were taken as the interval group(111 cases).The results showed that the average QRS time of free wall group was significantly widen compared with the interval group(t=13.500,P<0.01).There was no statistical significant difference among electrocardiogram lead I in IPVCs/IVT patients with tricuspid annular free wall originated from different parts(χ^(2)=6.876,P>0.05);QRS waves showed R type in lead I and aVL,rS type in lead V_(1)-V_(3),R type,in lead V_(5)-V_(6).The anterior lead transition region is more common in lead V_(3) or after,and R or RS or RS type was showed in the lower wall leads.In IPVCs/IVT patients originating from different parts of tricuspid annulus,ORS waves showed R-type in lead I,R-type or Rs-type in leadⅡ,QS-type or r S-type or Rs-type in leadⅢ,r S-type or rs-type or R-type in lead a VF,QS-type in lead V_(1),R-type in lead V_(5)-V_(6),and precordial lead transitional area was common in lead V_(2) to V_(3),or after lead V_(3).Conclusion The QRS wave characteristics of 12 lead electrocardiogram in IPVCs/IVT patients with tricuspid annulus originated from different parts of the body surface have certain differen

关 键 词：室性心律失常 特发性室性期前收缩 特发性室性心动过速 三尖瓣环 心电图 射频消融术 

分 类 号：R541.7[医药卫生—心血管疾病]