射频消融治疗起源于左室流出道的室性心动过速和频发室性期前收缩

Electrocardiographic characteristics and radiofrequency catheter ablation of ventricular tachycardia and frequent ventricular premature contractions originating from left ventricular outflow tract

目的探讨源自左室流出道部位的室性心动过速（室速）和室性期前收缩（室早）的心电图特点和射频消融的安全性。方法对9例于左室流出道部位消融的室速／室早病例的心电图和射频消融情况进行归纳总结。结果消融成功部位6例在左冠窦内，3例在主动脉瓣下。心电图特点：（1）Ⅱ、Ⅲ、aVF导联均呈高R波；（2）aVR和aVL导联均呈QS型，且aVL振幅多大于aVR；（3）I导联多呈QS型；（4）V1导联R波偏高：R／S〉0．62；（5）胸前导联R波移行不规则；（6）V5、V6多呈R型。9例均消融成功，无复发病例，无左主干及主动脉瓣损伤。结论源自左室流出道的室速／室早具有独特的心电图表现，射频消融能安全有效地根治此类心律失常。

Objective To investigate the electrocardiographic（ECG） characteristics and assess the safety of radiofrequency catheter ablation （RFCA） of ventricular tachycardia （VT）, and frequent ventricular premature contractions（VPCs） originating from left ventricular outflow tract（LVOT）. Methods Twelve-lead ECG analysis and RFCA were performed in 9 patient with VT or VPCs originating from LVOT. Results The sites to be successfully ablated were in left valsalva sinus in 6 patients, and subaortic valve in 3 patient. ECG revealed tall R wave in leads Ⅱ ,Ⅲ ,aVF, V s and V 6. QS morphology in both leads aVR and aVL, QS morphology in lead I in most cases. R wave in lead I was relative tall ,the R/S wave amplitude in lead V 1 was over 0.62 ,and precordia R wave transition was irregular. All 9 patients were successfully ablated. No death or recurrenced case during follow-up. Conclusion Ventricular tachycardia and frequent ventricular premature rcontractions originating from left ventricular outflow tract could be known by some specific ECG characteristics and could be radically treated safely by RFCA.