起源点邻近房室瓣环的特发性室性心律失常体表心电图特点及射频消融治疗

Electrocardiographic characteristics and radiofrequency catheter ablation results of ventricular tachycardia or premature ventricular contractions originating in the vicinity of atrioventricular annulus

目的评估起源点邻近房室瓣环附近的室性心动过速和室性早搏（室速／室早）的体表心电图特点及射频消融治疗效果。方法共19例特发性室速／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19例室速／室早术中均消融成功。10例起源于二尖瓣环附近，包括前侧壁（5例）、后侧壁（3例）、后间隔（2例）。9例起源于三尖瓣环附近，包括游离壁侧5例、间隔侧4例。对各组瓣环室速／室早心电图做进一步分析，可概括出系列心电图判断指标用以估计消融靶点的部位。结论起源点邻近房室瓣环附近的室速／室早是特发性室速／室早的一个亚组，射频消融治疗可取得良好效果，掌握其体表心电图特点有助于判定室速／室早的起源部位。

Objective To evaluate the electrocardiographic （ECG） characteristics and results of radiofrequency catheter ablation （RFCA） of idiopathic ventricular tachycardia or premature ventricular contractions （VT/PVCs） originating in the vicinity of atrioventricular annulus. Methods Nineteen patients with idiopathic VT/PVCs underwent conventional electrophysiological study and RFCA were included in this analysis. The 12 leads （ECG） characteristics were also analyzed. Results The VT/PVCs were originated in the vicinity of mitral annulus in 10 cases, including anterolateral （ n = 5 ） , posterolateral （ n = 3 ） and posteroseptal （ n = 2）. The VT/PVCs were originated in the vicinity of tricuspid annulus in the rest 9 cases, including the free wall （ n = 5 ） and the septal portion （ n = 4 ）. The 12-lead ECG patterns of VT/PVCs originating in the vicinity of atrioventricular annulus were helpful for determine the site of RFCA. The VT/PVCs were successfully eliminated by RFCA in all cases. Conclusion The exact origin of VT/PVCs originating in the vicinity of atrioventricular annulus could be determined by 12-leads ECG analysis and can be successfully and safely cured by RFCA.