胸前导联V3移行的流出道室性期前收缩左右心室起源体表心电图特点  

ECG characteristics of left and right ventricular origin in outflow tract premature ventricular contraction with V3 migration of precordial lead

作　　者：苗成龙[1] 王珏 徐璐 邢茹 贾妍[1] 黄柳[1] 王艳微[1] 刘素云[1] Miao Chenglong;Wang Jue;Xu Lu;Xing Ru;Jia Yan;Huang Liu;Wang Yanwei;Liu Suyun(Department of Cardiovascular Medicine,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心血管内科,石家庄050000

出　　处：《中国综合临床》2021年第3期243-249,共7页Clinical Medicine of China

基　　金：河北省科技支撑计划项目 (132777194)。

摘　　要：目的探讨胸前导联V3移行的流出道室性期前收缩中,右心室流出道(right ventricular outflow tract,RVOT)前间隔和右冠状动脉窦(right coronary cusp,RCC),以及RVOT中后间隔和左侧冠状动脉窦(left coronary cusp,LCC)的室性期前收缩左右心室起源的体表心电图特点。方法选取2017年1月至2019年9月就诊于河北医科大学第二医院的91例胸前导联呈V3移行且于RVOT前间隔及中后间隔、LCC和RCC部位成功行射频消融术的流出道室性期前收缩患者的临床资料,进行回顾性病例对照研究。分别比较RVOT前间隔组与LCC组,以及RVOT中后间隔组与RCC组室性期前收缩的体表心电图特征,包括Ⅰ、Ⅱ、Ⅲ、aVF导联R波振幅,Ⅲ导联与Ⅱ导联R波振幅比值,aVL、aVR导联Q波振幅、aVL导联与aVR导联Q波振幅的比值,V1~V3导联的R波和S波振幅,V2S/V3R指数,移行区指数和V2移行指数。结果起源于RVOT前间隔的室性期前收缩36例,LCC的11例。RVOT前间隔组I导联R波振幅高于LCC组[(0.22±0.25)mV与-(0.17±0.33)mV,P=0.003];Ⅱ导联R波振幅低于LCC组[(1.59±0.35)mV与(1.76±0.27)mV,P=0.035];aVF导联R波振幅低于LCC组[(1.53±0.35)mV与(1.78±0.39)mV,P=0.050];V2S/V3R指数两组间差异有统计学意义(1.99±0.66与0.76±0.38,P<0.001);V2移行指数在两组间差异有统计学意义(0.69±0.43与1.05±0.35,P=0.005)。起源于RVOT中后间隔的室性期前收缩32例,RCC的12例。RVOT中后间隔组的Ⅰ导联R波振幅低于RCC组[(0.25±0.31)mV与(0.57±0.12)mV,P<0.001];Ⅲ导联与Ⅱ导联R波振幅比值高于RCC组(0.89±0.14与0.72±0.18,P=0.002);aVL导联Q波振幅高于RCC组[(0.72±0.24)mV与(0.51±0.16)mV,P=0.002],aVL与aVR导联Q波振幅比值高于RCC组[0.76±0.23与0.50±0.21,P=0.002]。结论胸前导联V3移行的流出道室性期前收缩中,RVOT前间隔与LCC起源的室性期前收缩Ⅰ、Ⅱ、aVF导联R波及V2S/V3R指数、V2移行指数所有不同;RVOT后间隔及RCC起源的室性期前收缩Ⅰ导联R波、Ⅲ与Ⅱ导Objective To investigate the electrocardiographic characteristics of left and right ventricles origin of premature ventricular contractions(PVCs)during V3 transition of precordial leads,right ventricular outflow tract(RVOT)anterior septum and right coronary sinus(RCC),and RVOT middle-posterior septum and left coronary sinus(LCC).Methods From January 2017 to September 2019,91 patients with ventricular extrasystole of outflow tract who had V3 transition in precordial lead and had successful radiofrequency ablation in RVOT anterior septum,middle posterior septum,LCC and RCC were selected for retrospective case control study.The electrocardiography measurements of PVCs were compared between the anteroseptal RVOT group and RCC group,as well as the middle-posterior septal RVOT group and the LCC group,respectively.The measurements included the R-wave amplitude in leadⅠ,Ⅱ,Ⅲand aVF,R amplitude ratio in leadsⅢtoⅡ,Q-wave amplitude in lead aVL and aVR,Q amplitude ratio in leads aVL to aVR,R-wave and S-wave amplitude from leads V1 to V3,the V2S/V3R index,the transition zone index,and the V2 transition ratio.Results Thirty-six cases originated from the anteroseptal RVOT,and 11 from the LCC.Lead I R-wave amplitude in anterior septal RVOT was higher than LCC group((0.22±0.25)mV vs.(-0.17±0.33)mV;P=0.003).R-wave amplitude in leadⅡwas lower than that in the LCC group((1.59±0.35)mV vs.(1.76±0.27)mV;P=0.035).R-wave amplitude in lead aVF was lower compared with the LCC group((1.53±0.35)mV vs.(1.78±0.39)mV;P=0.050).The V2S/V3R index showed a significant difference between these two groups(1.99±0.66 vs.0.76±0.38;P<0.001).The V2 transition ratio also appeared a significant difference between the two groups(0.69±0.43 vs.1.05±0.35;P=0.005).PVCs arose from the middle-posterior septal RVOT in 32 cases,and from the RCC in 12 cases.Compared with RCC group,leadⅠR-wave amplitude showed lower((0.25±0.31)mV vs.(0.57±0.12)mV;P<0.001);R amplitude ratio in leadsⅢtoⅡhigher(0.89±0.14 vs.0.72±0.18;P=0.002);Q amplitude in

关 键 词：室性期前收缩 心电图 导管消融 流出道 V3移行 

分 类 号：R540.41[医药卫生—心血管疾病]