摘要
目的 分析心室基底部间隔侧起源室性心律失常(ventricular arrhythmias,VA)心电图特征以及消融.方法 回顾性分析2015年1月到2018年5月,阜外医院单病区经电生理检查证实起源于心室基底部间隔侧的VA病例资料.所有入选患者在X线透视及三维标测系统指导下通过激动顺序标测结合起搏标测确定消融靶点,10~40W放电消融.分析后间隔不同部位VA心电图特点,术后3、6个月及1年动态心电图随访VA数量判读手术疗效.结果 共入选的859例VA中,29例(3.4%)起源于心室基底部间隔侧,其中左心室基底部间隔侧11例、右心室基底部间隔侧18例.前间隔特别是邻希氏束区起源占比最高,随访4~42(21.6± 11.7)个月,消融成功率84% (24/29),无房室传导阻滞发生.右心室基底部间隔侧起源VA心电图特征:V1导联呈QS型或者“W”形;胸前导联移行在V2、V3导联,起源越靠后间隔,胸前导联移行越早;室性早搏起源由前到后间隔,Ⅱ、aVF、Ⅲ导联R波依次逐渐降低,S波逐渐加深(依次为Rs、RS、QS型).左心室基底部间隔侧起源VA心电图特征:V1导联呈qR或qr型;前间隔胸前导联以R波为主,少有s波;中、后间隔,V5、V6导联呈Rs型;下壁导联Ⅱ、aVF、Ⅲ导联从前、中到后间隔,逐渐R、RS、rS型过渡.结论 心室基底部间隔侧起源VA发病率较低,邻近希氏束区比例较高.心电图有较为特征性表现,消融风险可控,成功率较高.
Objective To evaluate the electrocardiographic (ECG) characteristics and radiofrequency catheter ablation (RFCA) efficacy for ventricular arrhythmias (VA) originating from ventricular basal-septum (VBS) areas.Methods Retrospective analyses of VA originating from VBS confirmed by electrophysiological study were conducted in Fuwai Hospital from January 2015 to May 2018.All the mapping and RFCA procedures were guided by both fluoroscopy and three dimensional mapping systems.The targets were demonstrated through activation and pace mapping.The characteristics of surface 12-lead ECG,efficacy of RFCA were analyzed.Results Among 859 consecutive VA cases,29 (3.4%) were confirmed as origin of VBS (11 cases were left VBS,18 cases right VBS separately).The ratio of para-His region origin was higher than other areas.After a mean follow up of 21.6± 11.7 (4-42) months,the overall success rate for RFCA of VA originating from VBS was 84% (24/29),no atrioventricular conduction block occurred.ECG characteristics of right VBS were:QS or W morphology on V1,the later the originating location,the earlier the precordial transition zone between V2 and V3.R wave decrease in Ⅱ,aVF,Ⅲ leads from anterior to posterior septum.ECG characteristics of left VBS were:qR or qr morphology on V 1.Dominant-positive R on precordial leads,rarely s wave in superior VBS.Rs morphology on V5 and V6 in mid-posterior VPS.R wave decrease in Ⅱ,aVF,Ⅲ leads from anterior to posterior septum (from R to RS and rS).Conclusion The prevalence of VA originating from VBS is relative low,and the ratio of para-His bundle origin is higher than that of other areas.There are distinctive ECG characteristics of VA originating from VBS which guided effectively ablation.
作者
丁立刚
梁二鹏
胡峰
郑黎晖
吴灵敏
牛国栋
陈刚
张澍
姚焰
Ding Ligang;Liang Erpeng;Hu Feng;Zheng Lihui;Wu Lingmin;Niu Guoclong;Chen Gang;Zhang Shu;Yao Yan(Center of Arrhythmia,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)
出处
《中华心律失常学杂志》
2019年第3期231-236,共6页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金(81200135)
国家重点研发计划资助(2017YFC1307800).
