多源性室性早搏的彩色多普勒组织成像检测

Examination of multifocal premature ventricular arrhythmias with Doppler tissue image

目的 应用彩色多普勒组织成像（Ｄｏｐｐｌｅｒｔｉｓｓｕｅｉｍａｇｅ，ＤＴＩ）的速度图、加速度图， 研究多源性室性早搏的起源与激动传播特征， 了解射频导管消融术（ＲＦＣＡ）治疗效果。方法 采用美国ＡｃｕｓｏｎＡｓｐｅｎ 彩色多普勒超声诊断仪， 检测７例频发性多源性室性早搏和２例伴有阵发室性心动过速行ＲＦＣＡ治疗患者。心电图同步启动， 观察多源室性早搏时， ＤＴＶ与ＤＴＡ图像上的特征性变化， 测量心室壁平均运动速度（Ｖ）与平均加速度（ΔＶ）。结果 ①７例发现心室壁兴奋灶共１６处， 其中２例各为３处、５例各为２处。②每处兴奋灶呈彩色亮点状， 与心电图等容收缩期同步出现，Ｖ为０．１０～０．１６ ｍ ／ｓ或－ ０．１３～－ ０．１５ ｍ ／ｓ， ΔＶ可略低于Ｖ，并将兴奋传向周围心肌， 引起心室提早除极。③ＲＦＣＡ 治疗１例无效， １例随访９个月未见复发。结论 ＤＴＶ与ＤＴＡ联合应用可互助准确诊断多源性室性早搏， 对判断各早搏起源区域及心肌兴奋传播与灌注特征。

Objective\ To study the origin and exciting disseminative characteristic of multifocal premature ventricular arrhythmias(MPVA) and to learn treatment effect on radiofrequency catheter ablation(RFCA). Methods\ It was examined with Doppler tissue image(DTI)(Acuson Aspen, USA) in seven cases with freguent MPVA and two cases with paroxysmal ventricular tachycardia afte RFCA, meanwhile ECG was open synthronously, as frequent MPVAs appear, its was observed on ECG and characteristic change on DTI, and average moving velocity (VDAI Rong *,YANG Bin, LIU Liping, et al. *The 95th Hospital of PLA,Putian 351100\; Abstract \ Objective\ To study the origin and exciting disseminative characteristic of multifocal premature ventricular arrhythmias(MPVA) and to learn treatment effect on radiofrequency catheter ablation(RFCA). Methods\ It was examined with Doppler tissue image(DTI)(Acuson Aspen, USA) in seven cases with freguent MPVA and two cases with paroxysmal ventricular tachycardia afte RFCA, meanwhile ECG was open synthronously, as frequent MPVAs appear, its was observed on ECG and characteristic change on DTI, and average moving velocity (V) in ventricular wall was measured. Results\ ①In seven cases total sixteen exciting foci were detected, three foci were detected separately in two cases, two foci were detectived separately in five cases. ②Color bright spot appeared in every exciting focus, accompanied with isovolume systolic phase synchronously. V was 0.10~0.16 m/s or -0.13^-0.15 m/s,Δ V may lower than V, its excite was spreaded around myocardium to bring about ventricular early depolarization. ③RFCA therapy: one case was invalid, one case didnit recur after following up nine months. Conclusions\ It is very significant to diagnose MPVA exactly , to determine every origin of premature beat and exciting dissemination and reperfusive feature and to follow up clinical treatment effect.\;