起源于三尖瓣环附近的室性心律失常的射频消融及心电图特征

Ventricular tachyarrhythmia originating from the tricuspid annulus:electrocardiogram analysis and radiofrequency catheter ablation

目的总结起源于三尖瓣环附近的室性心律失常的射频消融及心电图特征。方法 15例患者,根据心电图和/或动态心电图诊断为室性心动过速(VT)或频发室性早搏(VPC),均接受心脏电生理检查及射频消融治疗。消融成功后,结合靶点分布区域分析体表心电图。结果 15例消融均获成功,根据消融导管的X线影像特征及腔内电图判断均起源于三尖瓣环附近,不同区域起源的VT/VPC心电图表现各具特征,QRS波时限>140 ms、肢体导联见切迹、V1导联可见正向起始波及胸前导联移行区间≥V4判断起源于游离壁的特异度分别为100%、100%、100%、91.7%,敏感度分别为81.8%、90.9%、81.8%、100%。结论射频消融是治疗三尖瓣环附近起源的室性心律的安全、有效方法,心电图表现具其特征。

Objective To report the characteristics of electrocardiogram and the results of radiofrequency catheter ablation of ventricular tachyarrhythmia originating from the vicinity of the tricuspid annulus. Methods Fifteen patients, who were diagnosed as ventricular tachycardia（VT） or frequent premature ventricular contraction（PVC） by electrocardiogram or Hohor, underwent electrophysiological study and radiofrequency catheter ablation in our hospital. After a successful abla- tion was performed, the characteristics of electrocardiogram was analyzed in accordance with the location of target site. Results The arrhythmias were ablated successfully in all patients. VT/PVCs were demonstrated as originating from the vicinity of the tricuspid annulus by the appearances of X ray image and intracavitary electrogram. VT/PVCs originating from different portions were quite different with the characteristics of electrocardiogram. The specificities of QRS duration ≥ 140 ms, ＂notching＂ existing in limb leads, a positive initial component appearing in lead Vl and the precordial R-wave transi- tion occurring beyond lead V4 for VT/PVCs originating from the free-wall of annulus were 100%, 100%, 100%, 91.7%, and the sensitivities were 81.8%, 90.9%, 81.8%, 100%, respectively. Conclusion Radiofrequency catheter abla- tion could be effectively and safely utilized for treating VT/PVCs originating from the vicinity of the tricuspid annulus. The electrocardiogram of this kind of ventricular arrhythmia appeares characteristic patterns.