希氏束旁特发性室性心律失常的心电图特点

Electrocardiographic and electrophysiologic characteristics of idiopathic right ventricular arrhythmias originating near the His-bundle

目的探讨起源于希氏束旁的右室特发性室性心动过速/室性期前收缩(VT/VPCs)的心电图和电生理特征。方法入选3例起源于希氏束旁的右室特发性VT/VPCs患者,行12导联心电图及心内电生理检查,并行射频导管消融治疗。结果3例患者消融靶点记录到较清晰的希氏束电位,VT/VPCs下希氏束局部心室电位领先于体表心电图的QRS波群。所有患者I导联QRS波群均呈现单相高R波,aVL导联QRS波群均呈现R波,Ⅲ和aVF导联R波振幅明显低于Ⅱ导联,V1导联呈左束支阻滞形,VT/VPCs时QRS波群宽度较窄。结论起源于希氏束旁的VT/VPCs具有特征性的心电图表现,掌握这些特点有助于VT/VPCs的术前定位及提高导管消融的成功率。

Objective To investigate electrocardiographic （ECG） and electrophysiologic characteristics of idiopathic right ventricular tachycardia （VT）and ventricular premature contractions （VPCs）originating near the His-bundle. Methods Three patients with VT/VPCs originating from para-Hisian underwent catheter mapping and radiofrequency ablation. ECG and electrophysiologic characteristics were recorded. Results The ablation catheter of three patients had His-bundle potential and the His-bundle local ventricular electrogram preceded the QRS onset during VT/VPCs. Lead I exhibited signifcantly taller R wave amplitudes. An R wave in lead aVL was present in all three patients. The amplitude of R wave in leads Ⅲ and aVF was lower than lead Ⅱ. The QRS morphology was a left bundle branch block in lead V1 and QRS duration was narrow. Conclusion VT/VPCs originating from para-Hisian have distinctive ECG and electrophysiologic characteristics which may facilitate catheter mapping and successful ablation.