摘要
目的研究起源于主动脉窦（ASC）的室性心律失常，包括特发性频发室性早搏和室性心动过速（PVCs／VT）的心电图特点、电生理特征和经射频导管消融治疗方法学。方法15例频发PVCs／VT患者经右股静脉进右室流出道行最早激动顺序和起搏标测，消融不成功或失败的病例，采用经右股动脉途径行电生理检查，于心室及主动脉窦内标测PVCs／VT时最早心室激动（EVA），进行射频消融治疗，分析其体表心电图特点、电生理检查特征及经射频导管消融治疗结果。结果15例PVcs／VT患者，1例患者PVCs于无冠窦内消融成功，其体表心电图Ⅰ导联为顿挫的R波，aVL为rSr波，消融靶点局部心室激动提前体表QRS波18ms，放电1次4s终止PVCs；余14例于左冠窦内标测到EVA，其体表心电图呈不典型左束支传导阻滞伴心电轴右偏，Ⅰ导联为QS、rsr、rs或rs波，Ⅱ、Ⅲ、aVF导联为高振幅R波，V6均无S波，胸前导联R移行区12例位于V1～V3导联，仅2例位于V4导联，V1或V2导联R波时程指数≥50％者10例（71．40）、R／S波幅指数≥30％者11例（78．6％）。9例即刻消融成功者于左冠窦内标测到的EVA提前于体表心电图QRS波（EVA—QRS时间）（45．1±8．0）ms，而5例消融未成功者EVA—QRS时间为（26．4±5．9）ms（P〈0．05）。9例即刻消融成功者于消融靶点处可记录到位于PVCs／VTQRS波之前的高频低振幅电位（P1），窦性心律时于上述相同消融靶点处可记录到位于QRS波之后的高频低振幅电位（Pz），于消融靶点处放电1～3次，3～10s内终止PVCs／VT，消融后9例Pz电位均延迟；5例消融未成功者，2例于标测到EVA部位记录到P。电位。随访6个月至8年，10例即刻消融成功患者无复发；另5例消融未成功者1例服用倍他乐克心悸症状明显改善，1例服用心得安，心悸发作次数明显减少；余3例患者症状无改善。1例于左冠窦内�
Objective To examine the surface electrocardiogram features, electrophysiologic characteristics and the mapping and ablation of the frequency premature ventricular contractions or ventricu[ar tachycardia（PVCs/VT） originating from the aortic sinus cusp（ASC）. Methods Fifteen consecutive patients with PVCs/VT were referred for the electrophysiologic examination,the site with the earliest ventricular activation（EVA） was mapped and ablated in both of ventricle and the aortic sinus cusp. To analyze the surface electrocardiogram features, electrophysiologic characteristics and the results of the ablation of all the tachyarrhythmia mentioned above. Results In 1 patient with PVCs, PVCs were terminated in 4 seconds during the first radiofrequency in the non-coronary aortic cusp where the EVA preceding the QRS complex of PVCs by 18ms was recorded. The surface electrocardiogram showed a notched ＂ R ＂ pattern in lead Ⅰ, a ＂ rSr ＂ pattern in lead aVL. In the remaining 14 patients with PVCs/VT,the EVA was recorded from the left coronary cusp. The surface electrocardiogram showed QRS features of PVCs/VT included a typical left bundle branch block and right axis deflation, with a low amplitude ＂ rsr rs ＂ ＂ rS ＂ or ＂ QS ＂ patlqtern in lead I, a high amplitude ＂ R ＂ pattern in lead Ⅱ,Ⅲ, aVF, a ＂ R ＂ pattern in V6 ,precordial R wave transition zone in V1-V3 （12 in 14 patients, 85.7%）,the R wave duration index≥50% （10 in 14 patients, 71.4%）and R/S wave amplitude index≥30% （11 in 14 patients, 78.6%）determined for leads V1 and V2. The EVA recorded from the left coronary cusp preceded the onset of the QRS complex by （ 45.1±8.0）ms in 9 patients underwent successful catheter ablation and by （26.4 ±5.9）ms in 5 patients underwent failure catheter ablation （P〈0.05）. A presystolic potential preceding the QRS complex of PVCs/VT with high frequency and low amplitude （P1 potential） was recorded from the ablation target in 9 patients underwent successful catheter ab
出处
《中国心脏起搏与心电生理杂志》
2016年第1期34-40,共7页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心血管病学
主动脉窦
导管消融
射频电流
室性早搏
室性心动过速
Cardiology
Aortic sinus cusp
Catheter ablation, radiofrequency current
Premature ventrieular contractions
Ventricular tachycardia
