摘要
应用体表心电图对特发性节性心动过速（IVT）激动起源点进行分区、定位研究。将心室分为4个区11个部位。Ⅰ区即左室间隔，高、小、低3个那位；Ⅱ区即右主流出道，上、中、下和前后6个部位；Ⅲ区即注定游离壁；Ⅳ区即右室游离壁。20例（除外器质性心脏病）室上性心动过速射频消融成功后，大头导管在分区内起搏并记录12导联起搏心电图，据其特点总结出IVT起源的诊断标准。再根据诊断标准对39例消融成功的IVT病例进行IVT起源判断。结果：右室流出道IVT根据Ⅰ导联QRS波群形态特点分前后，胸前导联R波移行部位分上下。右室游离壁IVT表现为完全性左来支阻滞图形、电轴左偏。左定IVT根据电轴左偏的程度判定IVT起源部位。体表心电图诊断标准除对起源于左室中位间隔IVT诊断的灵敏度（50％）较低外，其余部位诊断的灵敏度、特异度和符合率均较高（75％～100％）。提示体表心电图对IVT起源点的定位有较高的预测价值。
To study originating site of idiopathic ventricular tachycardia (IVT) by using of 12-leads body-surface electrocardiogram (ECG). The whole ventricle endocardium was divided into 4 zones and 11 sites. Zone I was left ventricular septum upper,middle and lower sites. Zone Ⅱ was right ventricular outflow tract (RVOT) dlvlded into anterior-upper,anterior-middle anterior-lower site and posterior-upper,posterior-middle,posterior-Iower site. Zone Ⅲ was left free wall. Zone Ⅳ was right free wall. Experimental group included 2O paroxysmal supraventricular tachycardia (PSVT) patients without structuraI heart disease. In experimental control group, pacing stimuli were delivered at each site in each patient after successful treatment of PSVT,and surface 12-lead ECGs were recorded simutaniously. In control group, 39 cases of IVT entered control group. The surface ECGs during tachycardia and the successful ablation target point were recorded. Results: According to the type of QRS complex in lead 1 and the transition of R wave in chest leads, the originatlng site of the right ventricular outflow track tachycardia (RVOT) was further divided into anterior/posterior and upper/lower. In free wall of right ventricular tachycardia,the ECGs appeared left bundle branch block in character and left deviation axis. According to the degree of the frontal axis deviating left, the originating site of IVT could be locating. Above crlteria was higher sensitivity, specificity for quickly and accurately identifying the originating site of IVT through 12 lead body-surface ECG,except IVT from ventricular middle septum.
出处
《中国心脏起搏与心电生理杂志》
1999年第4期212-214,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
室性心动过速
特发性
起搏
心电图
分区
Ventricular tachycardia,idiopathic, Pacing, Electrocardiogram, Originating site
