摘要
目的分析肺动脉瓣上起源的室性早搏（premature ventricular contractions,PVCs）心电图特征和导管消融经验。方法回顾性分析4例在华山医院成功行导管射频消融治疗肺动脉瓣上起源PVCs的资料。结果体表心电图平均QRS波宽度为（151±3）ms（146~154 ms）,下壁导联振幅之和的平均值为（4.79±0.93）mV（3.76~5.64 mV）。3例下壁导联中Ⅲ导联振幅最高,2例avL/avR导联的QS比值大于1,3例胸导联移行为V4导联。2例标测过程中出现两种流出道起源图形的PVCs。4例成功导管射频消融靶点经造影证实位于肺动脉瓣上,肺动脉瓣上双极靶点电图领先体表心电图QRS波起点平均为（24±3）ms（22~28 ms）,4例患者均消融即刻获得成功,无消融相关并发症发生,远期随访中位数22个月无复发。结论手术过程中出现多种右室流出道起源形态的PVCs要高度注意肺动脉瓣上起源可能,采用导管消融肺动脉瓣上起源PVCs安全、有效。
Objective To analyze the electrocardiogram（ECG）characteristics and catheter ablation experience of premature ventricular contractions（PVCs）originating above the pulmonary valve.Methods A retrospective analysis on4 cases of PVCs originating above the pulmonary valve which had been successfully ablated in Huashan hospital. Results The average of QRS complex width was（151±3）ms（146-154 ms）,and the sum of the amplitude was（4.79±0.93）mV（3.76-5.64 mV）in inferior leads.Three cases showed the highest amplitude in LeadⅢ,and2 cases showed the QS ratio of avL/avR greater than1.The precordial transitional zone was observed at lead V4in3 cases.The two types PVCs originating from right ventricular outflow tract（RVOT）were found during the mapping procedure in 2 cases.All successful targets were located above the pulmonary valve confirmed by angiography.The time of the bipolar electrocardiogram leading surface QRS complex at the final target was an average of（24±3）ms（22-28 ms）.The instant success was achieved in all cases without ablation-related complications.No recurrence episodes were detected after a mean follow-up of 2 2 months.Conclusions Detecting the various RVOT morphologic PVCS during ablation procedure should pay highly attention to the pulmonary valve origin.Catheter ablation of PVCs originating above the pulmonary valve was safe and effective.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2016年第3期333-337,共5页
Fudan University Journal of Medical Sciences
关键词
导管消融
肺动脉瓣
室性早搏
catheter ablation
pulmonary valve
premature ventricular contractions
