摘要
目的探讨体表12导联心电图V_1呈qrS或QS型伴下降支有顿挫的流出道室性期前收缩/室性心动过速(PVC/VT)的心电图特征及射频消融结果。方法 2008年1月至2015年4月,在V_1呈qrS或QS型伴下降支有顿挫且射频消融成功的流出道PVCs/VT患者29例纳入本研究。记录12导联同步心电图,分析PVCs/VT时的QRS波群特征以初步判断其来源;在常规X线透视和三维标测系统EnSite—NavX或CartoXP或Carto 3指导下完成标测与消融术。结果 V_1呈qrS型22例,QS型伴下降支有顿挫7例;V_2呈qrS型3例,QS型伴下降支有顿挫1例,rS或RS型25例;经右心室流出道(RVOT)消融成功17例,左心室流出道(LVOT)消融成功12例[其中左冠窦(LCC)3例、右冠窦(RCC)1例,左右冠窦交界处(L—RCC)7例,左冠窦下(ILCC)1例];根据胸导联移行指数<0判断LVOT起源,I呈r或m型判断L—RCC及RCC起源,其敏感度、特异度、阳性预测值、阴性预测值分别为91.7%、94.1%、91.7%、94.1%与87.5%与50.0%、77.8%、75.0%。结论 V_1呈qrS或QS型伴下降支有顿挫的流出道PVCs/VT并非均起源于L—RCC,亦可能起源于RVOT、RCC、LCC及ILCC,根据胸导联移行指数<0预测LVOT起源,再结合I的QRS形态来预测其主动脉窦的具体起源简单可行。
Objective To investigate electrocardiogram characteristics of frequent premature ventricular contraction/ ventricular tachycardia （PVCs/VT） originating from ventricular outflow tract presenting qrS or QS type in lead V1 and its relation to the efficacy of radiofrequency catheter ablation （RFCA）. Methods Twenty nine patients, who were successfully mapped and ablated, featuring surface electrocardiogram （ECG） of PVC with qrS or QS morphology in lead V1 were analyzed. Results There were 22 cases with qrS morphology and 7 with QS morphology in lead V1 with a notch on the downward deflection;while 3 with qrS morphology,1 QS morphology following a notch on the descending portion and 25 with rs or RS morphology in lead V2. Among 29 patients, 17 cases were ablated via right ventricular outflow tract（RVOT） and 12 via left ventricular outflow tract （LVOT）. When the precordial transitional zone index （TZ index）〈0 was used for predicting LVOT origin and ＂r＂ or ＂R＂ or ＂Rs＂ morphology in lead I with forward wave for predicting the L-RCC and RCC origin, the sensitivity was 91.7% and 87.5%, the specificity was 94.1% and 50.0%, the positive predictive value was 91.7% and 77.8%, the negative predictive value was 94.1% and 75.0%, re- spectively. Conclusion Surface ECG of PVC with R morphology in lead II, III, aVF and qrS morphology or QS morphology with a notch on the downward deflection in lead V1, can predict the PVC originating from LVOT according to the precordial transitional zone index （TZ index）〈0. It is convenient and viable to predicte the specific originating of aortic sinus cusp （ASC） combing with the QRS-wave morphology in lead I with forward wave.
出处
《浙江医学》
CAS
2016年第7期459-464,共6页
Zhejiang Medical Journal
基金
温州市重大科研项目(Y2008086)
浙江省科技厅项目(2016C33G2090058)
关键词
室性期前收缩
射频消融
心电图
心室流出道
Prematureventricular contration Radiofrequency ablation Electrocardiogram Ventricular outflow tract
