摘要
目的探讨心大静脉远端（DGCV）不同部位特发性室性心律失常（VA）的心电图特征。方法研究纳入2009年7月至2016年3月于温州医科大学附属第二医院心内科行射频消融治疗成功的49例DGCV不同部位室性早搏（PVC）/室性心动过速（VT）患者，根据标测及消融结果分为4个亚组：DGCV1组（二尖瓣环前侧壁的心外膜处）10例、DGCV2组（前室间静脉开口处）13例、前室间静脉近端（PAIV）组17例和心大静脉远端延伸支（EDGCV）组9例。分析DGCV不同部位PVC/VT的体表12导联心电图特征的异同，并与使用系统抽样法选取的290例心室流出道及邻近结构起源的PVC/VT进行比较。结果所有患者共同的心电图特征是Ⅱ、Ⅲ、aVF均呈单向R波，aVR、aVL均呈QS型。但不同部位的心电图特征亦有不同：（1）EDGCV组6例（6/9）在Ⅰ导联呈R或r型，其他3组呈rS或qr型占39例（39/40）；（2）DGCV2组11例（11/13）在V1、V5和V6均呈单向R波，仅有1例在V1呈Rs型，2例在V5～V6呈Rs型；DGCV1组9例（9/10）在V1呈R型，V5～V6呈RS或Rs型，仅1例在V1呈Rs型，V5～V6呈R型；而PAIV组和EDGCV组则相反，25例（25/26）在V1呈rS或RS型，V5～V6均呈R型；（3）胸前导联移行区DGCV1及DGCV2组23例（23/23）在V1之前，EDGCV组在V1～V3，而PAIV组常在V2或V2～V3之间；（4）与PAIV组和EDGCV组比较，DGCV1组和DGCV2组假性δ波时间、类本体波时间及最大偏转指数值更大（P均〈0.001）；（5）DGCV不同部位与290例心室流出道及邻近结构起源的PVC/VT进行比较，其12导联心电图形态有以下特征：①PAIV与左冠状动脉窦（LCC）类似，在Ⅰ导联呈rs型，V1～V2呈rS型，V5～V6呈R型；②EDGCV与右冠状动脉窦（RCC）类似，Ⅰ导联呈R或r型，胸前导联的QRS波形态与PAIV与LCC相似；③DGCV2与左冠状动脉窦下类似，V1、V5和V6均呈R型；④DGCV1与二尖瓣环前壁心内膜类似，V1呈R，V5～V6呈Rs�
ObjectiveTo explore the electrocardiographic characteristics of patients with idiopathic ventricular arrhythmias （VAs） originating from different portions of distal great cardiac veins （DGCV）.MethodsThe study included 49 patients underwent successful RFCA of premature ventricular complex（PVCs）/ventricular tachycardia（VT） from different portions of the DGCV in our department from July 2009 to March 2016. The surface 12-lead electrocardiogram （ECG） and intraventricular ablation mapping features were analyzed. Patients were divided into four groups according to the mapping and ablation results： DGCV1（10 patients）, DGCV2 （13 patients）, proximalanterior interventricular vein （PAIV, 17 patients）and extend distal great cardiac vein （EDGCV, 9 patients）. We analyzed the similarities and differences between surface 12-lead ECG of patients with PVCs/VT from different portions of DGCV, and compared with random chosen 290 patients with PVCs/VT from ventricular outflow tract and adjacent structure.ResultsA positive R wave in inferior leads, a negative QS morphology in lead aVL and aVR were found among all groups. The different characteristics of surface 12-lead ECG of VAs originating from DGCV were as follows： （1）EDGCV patients demonstrated a positive R or r wave on lead Ⅰ（6/9） while a negative rS or qr wave was evidenced in other three groups （39/40）. （2）A positive R pattern on lead V1, V5-V6 （11/13） was presented in patients of DGCV2 group; R （without S or s） wave on V1 （9/10）, RS or Rs wave on V5-V6 were found in DGCV1 group; RS or rS wave was seen on lead V1, R（without S）wave in lead V5-V6 （25/26） were found in EDGCV and PAIV group and the amplification of R wave in EDGCV was higher than V1 of PAIV group.（3）Precordial lead transition zone was in front of V1 for DGCV1 and DGCV2 groups （23/23）, within V1-V3 for EDGCV group, but on V2 or within V2-V3 for PAIV group.（4）Patients of DGCV1 and DGCV2 demonstrated a longer Pseudo delta wave ti
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2017年第4期307-313,共7页
Chinese Journal of Cardiology
基金
浙江省科技厅项目（2016C33181）
温州市重大科研项目（Y2008086）
关键词
室性早搏复合征
导管消融术
心脏电生理学
Ventricular premature complexes
Catheter ablation
Cardiac electrophysiology
