心内膜和心外膜消融的summit区室性早搏:心电图特征和远期预后  

Endocardial and epicardial ablation of premature ventricular complex arising from the summit:ECG characteristics and long-term prognosis

作　　者：胡晓侠 黄颖[1] 伍梦佐[1] 赵韧[1] HU Xiaoxia;HUANG Ying;WU Mengzuo;ZHAO Ren(Department of Cardiovascular,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院心血管内科,安徽省合肥市230022

出　　处：《中国动脉硬化杂志》2023年第7期594-599,共6页Chinese Journal of Arteriosclerosis

基　　金：安徽高校省级自然科学基金项目(KJ2014A122)。

摘　　要：[目的]分析summit区室性早搏体表12导联心电图,识别是否存在可以精准判断有效消融靶点的心电图特征。[方法]选择2018年6月—2021年2月期间在冠状窦内或对应的左心室心内膜面行summit区室性早搏射频消融术患者36例,回顾性分析其体表12导联心电图报告。[结果]25例患者的有效消融靶点位于心内膜面的临近部位(心内膜组),余11例患者的有效消融靶点位于心外膜的心大静脉和前室间静脉(GCV-AIV)区(心外膜组)。心内膜组的类本位曲折(ID)显著小于心外膜组,差异有统计学意义(P=0.022)。心内膜组的最大转折指数(MDI)明显小于心外膜组,差异有统计学意义(P=0.020)。心内膜组的假性δ波时限显著短于心外膜组,差异有统计学意义(P=0.004)。随访6~36个月,心外膜组消融成功率为100%(11/11),心内膜组失访1例,余24例患者的消融成功率为87.5%(21/24)。心内膜组亚组分析显示,当假性δ波时限≥25 ms时消融成功率仅为62.5%(5/8),但当假性δ波时限<25 ms时消融成功率为100%(16/16)。假性δ波时限<25 ms对心内膜面消融成功预判的灵敏度和特异度分别为94%和72%。[结论]summit区室性早搏心电图上假性δ波时限<25 ms与心内膜面导管射频消融的成功率密切相关。Aim To analyze the 12-lead surface ECG of premature ventricular complex(PVC)originating from the summit to identify some ECG characteristics that may accurately determine the ablation target.Methods Between June 2018 and February 2021,a total of 36 patients with PVC arising from the summit underwent percutaneous radiofrequency catheter ablation(RFCA)in the coronary venous circulation or opposite left ventricular endocardial sites.The 12-lead ECG recordings about these patients were analyzed.Results 25 patients successfully ablated from the endocardial approach(endocardial group),11 patients successfully ablated from the coronary venous circulation(epicardial group).The intrinsicoid deflection(ID)was smaller in the endocardial group than that in the epicardial group,and the difference was statistically significant(P=0.022).The maximum deflection index(MDI)was smaller in the endocardial group than that in the epicardial group,and the difference was statistically significant(P=0.020).The duration of the negative pseudodelta wave was shorter in the endocardial group compared to the epicardial group,the difference was statistically significant(P=0.004).After follow-up 6~36 months,the RFCA success rate was 100%(11/11)in the epicardial group,1 case in the endocardial group was lost,and the RFCA success rate was 87.5%(21/24)in the remaining 24 patients.Subgroup analysis of the endocardial group showed when the duration of the negative pseudodelta wave≥25 ms,the RFCA success rate was 62.5%(5/8),and when the duration of the negative pseudodelta wave<25 ms,the RFCA success rate was 100%(16/16).The duration of the negative pseudodelta wave<25 ms had sensitivity and specificity of 94%and 72%,for the identification of successful ablation in the adjacent endocardium.Conclusion The negative pseudodelta wave of PVC originating from the summit<25 ms was closely related to the success rate of RFCA.

关 键 词：summit区 心电图 室性早搏 心内膜消融 心外膜消融 

分 类 号：R5[医药卫生—内科学]