左冠窦起源室性心律失常电生理特征及消融治疗结果  

Electrophysiological characteristics and ablation results of ventricular arrhythmias originating from leftcoronarysinus

作　　者：林维谦 郑程[1] 李嘉[1] 林元楠 林加锋[1] Lin Weiqian;Zheng Cheng;Li Jia;Lin Yuannan;Lin Jiafeng(Department of Cardiology,The Second Afiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University,Wenzhou325000,China)

机构地区：[1]温州医科大学附属第二医院,育英儿童医院心内科,温州325000

出　　处：《中华心律失常学杂志》2024年第2期161-168,共8页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(82070333);浙江省自然科学基金(LY21H020011);温州市重大科研项目(ZY2020018)。

摘　　要：目的探讨起源于左冠窦(LCC)室性心律失常(VA)的心电图、腔内双极电图特征及消融治疗结果。方法本文为描述性研究。回顾性分析2011年1月1日至2021年12月31日于温州医科大学附属第二医院心内科行消融术的270例LCC-VA患者,采用系统抽样法按1:1选取同期住院并经射频消融治疗成功的270例右心室流出道VA(RVOT-VA)患者作为对照组,比较两组心电图、靶点双极电图特征及消融治疗结果等。结果共纳入270例LCC-VA患者,年龄(55.94±15.74)岁,其中男105例。①消融成功260例(96.3%,260/270),失败10例(3.7%,10/270),78.46%(204/260)有效靶点在LCC前壁中上部,21.54%(56/260)在LCC前壁窦底部。②心电图特点:最常见类型为Ⅰ导联以负向波为主呈rs、qs或qr型,V_(1)~V_(2)导联呈rS、RS或Rs型且R波振幅指数>0.3及R波时限指数>0.5,胸导联移行指数<0,占79.63%;其他如RVOT后间隔、左右冠窦之间(L-RCC)、右冠窦(RCC)及主动脉瓣二尖瓣连接处(AMC)起源较少见,分别占11.85%、1.48%、2.59%及4.44%。③与对照组相比,两组患者心电图存在多种差异,最大差异为胸导联移行指数<0,分别为92.22%(249/270)与11.85%(32/270),χ^(2)=349.387,P<0.001;若以胸导联移行指数<0作为区分LCC-VA与RVOT-VA的指标,其敏感度、特异度、阳性与阴性预测值分别为92.22%、88.15%、88.61%、91.89%。④78.46%(204/260)LCC-VA患者有效靶点腔内双极电图可见特殊心室电位,其中86.27%(176/204)呈低幅碎裂电位,13.73%(28/204)呈高幅碎裂电位,27.94%(57/204)伴特殊电位反转。结论LCC-VA患者的心电图及有效靶点腔内双极电图具有明显特点,胸导联移行指数可有效定位LCC与RVOT,绝大部分LCC-VA能被成功消融,中上部起源的LCC-VA消融时应注意冠状动脉风险。Objective To investigate the electrocardiogram(ECG),bipolar intracardiac electrogram(BIE)features and radiofrequency catheter ablation(RFCA)outcomes of ventricular arrhythmias(VA)originating from left coronary cusp(LCC).Methods This was a descriptive research.Retrospective analysis of 270 patients with LCC-VA who underwent RFCA in The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 1,2011 to December 31,2021 were included in this study.Two hundred and seventy right ventricular outflow tract VA(RVOT-VA)patients who underwent successful RFCA in our center during the same period were also enrolled in this study by the random systematic sampling method in 1:1 ratio as the control group.The features of ECG,BIE and the RFCA results of two groups were compared.Results A total of 270 LCC-VA patients were included aged(55.94±15.74)years,with 105 males.①Ablation was successful in 260 cases(96.3%,260/270),while 10 cases(3.7%,10/270)failed.Senenty-eight point forty-six percent(204/260)of the target sites were in the upper middle and upper part of the anterior wall of LCC and 21.54%(56/260)were at the bottom of the sinus of the anterior wall of LCC.②The ECC in LCC origin had distinctive features.Seventy-nine point sixty-three percent of lead I showed mainly negative waves,which were rs,qs or qr types,leadV_(1)or V_(2)showed rS,RS or Rs types,while R wave amplitude index>0.3 and R wave duration index>0.5 and transition index<0.Meanwhile,there were a series of types similar to the RVOT posterior septum origin,the junction ofleft and right coronary sinus(L-RCC)origin,the right coronary sinus(RCC)origin or aortomitral continuity(AMC)origin which accounted for 11.85%,1.48%,2.59%,and 4.44%,respectively.③Compared with 270 cases of RVOT-VA randomly during the same period,there were various differences in ECG between the two groups.The most distinctive difference was the transition index of the precordial leads was<0,which were 92.22%(249/270)in LCC group and 11.85%(32/270)in

关 键 词：电生理学 室性心律失常 左冠窦 导管消融术 腔内双极电图 

分 类 号：R541.7[医药卫生—心血管疾病]