起源点邻近二尖瓣环的频发室性早搏体表心电图特征及射频消融治疗

Electrocardiographic characteristics and radiofrequency catheter ablation of frequent premature ventricular contraction originating in the vicinity of the mitral annulus.

目的评估起源点邻近二尖瓣环的频发室性早搏(简称室早)体表心电图特点及射频消融治疗效果。方法10例频发室早患者接受常规电生理检查及射频消融治疗,对所有病例12导联体表心电图进行分析。结果10例室早均消融成功,并证实起源点邻近二尖瓣环的不同部位,根据成功消融靶点将本组病例分为3组,二尖瓣环前侧壁组(4例)、二尖瓣环后侧壁组(3例)、二尖瓣环后间隔组(3例)。所有病例胸前导联R波移行区位于V1～V2导联,绝大部分病例V6导联可见s波。对各组二尖瓣环室早心电图做进一步比较,可概括出系列心电图判断指标用以估计消融靶点的部位。结论射频消融治疗起源点邻近二尖瓣环的频发室早可取得良好效果,掌握其体表心电图特点有助于判定室早的起源部位。

Objective To evaluate the electrocardiographic （EGG） characteristics and the results of radiofrequeney catheter ablation （RFCA） of frequent premature ventrieular contraction （PVC） originating in the vicinity of the mitral an- nulus. Methods Ten patients with frequent PVC underwent conventional alectrephysiological study and RFCA . The 12 leads （ECG） eharaoteristics were analyzed. Results The PVCs were proved to originate in the vicinity of the mitral an- nulus and were successfully eliminated by RFCA in all cases. The exact sites of origin of PVCs were classified into three groups according to the successful ablation sites around the mitral annulus ： the anterolateral group （ n = 4）, the posterelateral group （ n = 3 ） and the posteroseptal group （ n = 3 ）. The transitional zone of the R wave occurred between V1 -V2 in all cases. In most cases, a s-wave was present in lead V6. The 12-lead ECG pattens of PVCs originating in the vicinity of the mitral annulus were compared among different groups and we proposed an algorithm for predicting the site of the focus nee- ded for successful RFCA. Conclusion PVCs originating in the vicinity of the mitral annulus can be successfully treated by RFCA. The exact origin of these PVCs could be determined by 12-leads ECG analysis. [ Chinese Journal of Cardiac Pa- cing and Electrophysiology ,2008,22 （ 5 ） ：400 - 403 ]