肺动脉窦内起搏十二导联多导心电图特征分析  

The analysis of twelve-lead ECG characteristics of pacing originating within the pulmonary artery sinus

作　　者：汪晓敏 章晨 包程鸿 潘轶斌 Wang Xiaomin

机构地区：[1]浙江大学医学院附属金华医院,321000

出　　处：《浙江临床医学》2024年第11期1612-1614,共3页Zhejiang Clinical Medical Journal

基　　金：金华市科技计划项目(2021-4-016);浙江省医学会临床科研基金项目(2021ZYC-A41)。

摘　　要：目的通过导管技术将起搏器电极放置于肺动脉前窦、左窦、右窦,以获取十二导联心电图,分析这些窦区起搏时的心电图特征,从而为右室流出道室性早搏的定位和消融治疗提供参考。方法选取在2021至2023年间本院诊断为流出道室性早搏并接受射频消融手术患者40例。在手术过程中,消融导管被塑成倒U形,送至肺动脉三个窦区内。通过右前斜30°和左前斜45°的造影技术确认导管位置后,进行起搏以获得三个窦区内的十二导联心电图。结果在40例患者中,成功获取了105份肺动脉窦内起搏心电图,其中右窦34份、前窦35份、左窦36份。右窦起搏时的心电图特征如下:83.3%的情况下,Ⅰ导联形态呈正向波;64.7%的情况下,胸导联R波移行晚于V3导联;在下壁导联(Ⅱ、Ⅲ、AVF)中,73.5%、64.7%和70.6%的情况存在降支切迹。这些特征与左窦和前窦起搏时的心电图特征相比,差异有统计学意义(P<0.05)。前窦与左窦之间的比较显示,I导联形态差异有统计学意义,而胸导联的移行和下壁导联的降支切迹无差异(P>0.05)。结论肺动脉右窦、前窦和左窦起搏时产生的十二导联心电图有各自的特征。掌握这些特征对于临床医师在进行右室流出道室早的定位和消融治疗时具有重要参考价值,有助于提高手术成功率和效率。Objective To place pacing electrodes in the anterior sinus,left sinus,and right sinus of the pulmonary artery using catheter technology to obtain twelve-lead multilead electrocardiogram(ECG)and to analyze the ECG characteristics during pacing in these sinuses,thereby providing references for the localization and ablation treatment of right ventricular outflow tract(RVOT)premature ventricular contractions(PVCs).Methods A total of 40 patients diagnosed with PVCs of the RVOT who underwent radiofrequency ablation at our hospital from 2021 to 2023 were included.During the procedure,the ablation catheter was manipulated into a reversed U-curve position within the three sinuses of the pulmonary artery,confirmed by contrast imaging at right anterior oblique 30 degrees and left anterior oblique 45 degrees.Twelve-lead ECGs were obtained through pacing in each of the sinuses.Results A total of 105 ECGs were successfully obtained from the 40 patients during pulmonary sinus cusp pacing.The ECG characteristics for pacing from the right sinus were distinct,with 83.3%showing a positive wave in lead I,and 64.7%showing a migration of the thoracic leads later than the V3 leads.The lower wall leads(II,III,and AVF)had a descending branch notch in 73.5%,64.7%,and 70.6%of cases,respectively,which was statistically different from the characteristics observed with pacing from the left sinus and anterior sinus(P<0.05).There was no statistical difference in thoracic lead migration and the descending branch incisor of the lower wall lead while comparing the left sinus to the anterior sinus,except for the morphology of lead I(P>0.05).Conclusion The twelve-lead ECGs produced during pacing in the right sinus,anterior sinus,and left sinus of the pulmonary artery each have their unique characteristics.Understanding these ECG characteristics is of significant reference value for clinicians during the localization and ablation treatment of right ventricular outflow tract PVCs,which can improve the success rate and efficiency of the surgery.

关 键 词：右室流出道室性早搏 射频消融 起搏心电图 肺动脉窦 

分 类 号：R541.7[医药卫生—心血管疾病]