右心室流出道肺动脉瓣上和瓣下起源室性心律失常的体表心电图分析

Surface electrocardiogram analysis of supravalvular and subvalvular ventricular arrhythmias originating from right ventricular outflow tract

目的对右心室流出道(RVOT)肺动脉瓣上和瓣下起源的室性心律失常(VAs)患者体表心电图特征进行对比分析,以实现VAs的较精确定位。方法纳入2018年10月到2022年10月在解放军总医院第一医学中心行射频消融术治疗的139例RVOT起源VAs患者进行研究,根据起源点与肺动脉瓣的位置关系分为瓣上起源组和瓣下起源组,进行心电图参数分析。结果139例RVOT起源VAs患者中,71例(51.1%)VAs起源于肺动脉瓣上,其中左窦43例(30.9%),右窦11例(7.9%),前窦7例(5.0%),左右窦交界10例(7.2%);68例(48.9%)VAs起源于肺动脉瓣下,其中游离壁侧14例(10.1%),室间隔侧54例(38.8%)。肺动脉瓣上起源组VAs心电图Ⅱ导联和aVF导联R波振幅显著高于肺动脉瓣下起源组VAs;在亚组分析中,肺动脉瓣上不同位置起源VAs体表心电图存在显著差异,肺动脉瓣下游离壁起源VAs心电图QRS波时程显著大于室间隔侧起源VAs,下壁导联QRS波切迹发生率显著大于室间隔侧起源VAs。结论起源于肺动脉瓣上和瓣下的VAs具有不同的体表心电图表现,可根据体表心电图表现初步判断VAs的起源点位置。

Objective To explore the electrocardiogram(ECG)characteristics of the patients with ventricular arrhythmias(VAs)originated from supravalvular and subvalvular right ventricular outflow tract(RVOT)so as to locate the VAs accurately.Methods A total of 139 patients with VAs originating from RVOT who underwent radiofrequency ablation in the First Medical Center of PLA General Hospital from October 2018 to October 2022 were enrolled.According to the location of the origin point to the pulmonary valve,they were divided into the supravalvular origin group and subvalvular origin group.Results Among 139 patients with VAs originating from RVOT,71patients(51.1%)had VAs originating from the supravalvular region,including 43(30.9%)in the left sinus,11(7.9%)in the right sinus,7(5.0%)in the anterior sinus and 10(7.2%)in the junction between the left and right sinuses;68 patients(48.9%)had VAs originating from the subvalvular region,including 14(10.1%)from the free wall and 54(38.8%)from the ventricular septum.The R wave amplitude in leadⅡand aVF of VAs in patients with supravalvular origin was significantly higher than that in patients with subvalvular origin.In the supravalvular origin group,there were significant differences in the surface electrocardiogram of VAs originating from different supravalvular locations.The QRS duration of VAs originating from the subvalvular free wall was significantly longer than that of VAs originating from the ventricular septum,and the incidence of QRS notch in the inferior leads was significantly higher than that of VAs originating from the ventricular septum.Conclusions VAs originating from supravalvular and subvalvular regions of pulmonary artery have different electrocardiographic features.The origin of VAs could be preliminarily judged according to the electrocardiographic features.