邻近左房室瓣环间隔与游离壁起源的特发性室性期前收缩/特发性室性心动过速患者的心电图特征及其鉴别诊断研究  

Electrocardiogram Characteristics and Differential Diagnosis of Idiopathic Premature Ventricular Contraction/Idiopathic Ventricular Tachycardia with the Origin of Left Atrioventricular Annulus Septum and Free Wall

作　　者：王婷婷 王一丹 王蓉 WANG Tingting;WANG Yidan;WANG Rong(Department of Cardiovascular,Beijing Aerospace General Hospital,Beijing 100072,Chin)

机构地区：[1]北京航天总医院心血管内科,北京市100072

出　　处：《实用心脑肺血管病杂志》2021年第7期86-91,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景特发性室性期前收缩(IPVC)和特发性室性心动过速(IVT)多起源于左心室中后间隔和右心室流出道,但经临床实践发现,不少患者起源于非典型部位,如起源于左房室瓣环等,而该类患者的电生理特征目前尚无确切定论。目的分析邻近左房室瓣环间隔与游离壁起源的IPVC/IVT患者的心电图特征及其鉴别诊断,以期为临床诊疗提供参考。方法回顾性分析2016年1月-2020年6月北京航天总医院收治的96例邻近左房室瓣环起源的IPVC/IVT患者的临床资料,根据起源部位的不同将所有患者分为A组(邻近左房室瓣环间隔起源)51例和B组(邻近左房室瓣环游离壁起源)45例。患者均于进行射频消融治疗前行12导联同步心电图检查。比较两组患者射频消融治疗成功率、不同起源部位患者的心电图特征及胸前导联QRS波群特征。绘制受试者工作特征(ROC)曲线评价心电图胸前导联R、S波振幅对邻近左房室瓣环间隔、游离壁起源的IPVC/IVT的鉴别诊断价值。结果B组患者射频消融治疗成功率高于A组(P<0.05)。A组不同起源部位患者Ⅱ、Ⅲ导联的r(R)、s(S)波,QS_(aVR)、R_(aVL)波,aVF、V1导联的r(R)、s(S)波,V_(3)导联的r(R)波振幅比较,差异有统计学意义(P<0.05);B组不同起源部位患者Ⅱ、Ⅲ导联的r(R)、s(S)波,R_(Ⅰ)、QS_(aVR)、R_(aVL)波,aVF导联的r(R)、s(S)波,V_(2)导联的s(S)波,V_(4)导联的r(R)波,RV_(5)波振幅比较,差异有统计学意义(P<0.05)。A、B组Ⅰ、aVL、V_(5)~V_(6)导联以R波多见,少见左房室瓣环前侧壁、前间隔起源者于aVL导联出现qs、qr波。A组前间隔起源者心电图主要表现为Ⅱ、Ⅲ、aVF导联QRS波群多为正向波,且r、R波振幅Ⅲ导联<aVF导联<Ⅱ导联,s、S波振幅Ⅱ导联<aVF导联<Ⅲ导联,aVR导联多为负向波。B组V1~V_(3)导联以rS波为多见,V_(4)导联则呈现R、Rs、RS、rS或rSr'波,B组由左房室瓣间隔、游离壁上部、中部、下部,下壁导联R波递�Backgroud Idiopathic premature ventricular contraction(IPVC)and idiopathic ventricular tachycardia(IVT)mostly originate from the left ventricular middle posterior septum and right ventricular outflow tract.However,clinical practice have found that many cases originate from atypical parts,such as left atrioventricular annulus.There is no definite view on the electrophysiological characteristics of these patients.Objective To analyze the electrocardiogram characteristics and differential diagnosis of IPVC/IVT with the origin of left atrioventricular annulus septum and free wall,in order to provide reference for clinical diagnosis and treatment.Methods Clinical data of 96 patients with IPVC/IVT with the origin of left atrioventricular annulus from January 2016 to June 2020 in Beijing Aerospace General Hospital.According to the location of origin,51 cases were divided into group A(adjacent left atrioventricular annulus septum)and 45 cases were divided into group B(adjacentleft atrioventricular annulus free wall).Patients were given 12-lead synchronous electrocardiogram examination before radiofrequency ablation therapy.Success rate of radiofrequency ablation,electrocardiogram characteristics of patients with different origin parts and QRS complex characteristics of chest lead were compared between the two groups,and receiver operating characteristic(ROC)curve was drawn to evaluate the differential value of R and S wave amplitude of anterior lead in IPVC/IVT with the origin of left atrioventricular annulus septum and free wall.Results The success rate of radiofrequency ablation therapy in group B was significantly higher than that in group A(P<0.05).In group A,there were statistically significant differences in amplitude of r(R),s(S)in leadsⅡandⅢ,QS_(aVR),R_(aVL)waves,r(R),s(S)waves in leads aVF and V1,and r(R)wave in lead V_(3)among patients with different origin parts(P<0.05);in group B,there were statistically significant differences in amplitude of r(R)and s(S)waves in leadsⅡandⅢ,R_(Ⅰ),QS_(aVR),R_(aVL)wa

关 键 词：特发性室性期前收缩 特发性室性心动过速 左房室瓣环 间隔部 游离壁 心电图 

分 类 号：R541.7[医药卫生—心血管疾病]