起源于主动脉窦与二尖瓣环交界处的室性心律失常心电图特征及射频消融

Ventricular arrhythmias originating from the junction of the aortomitral continuity: electrocardiogram characteristics and radiofrequency catheter ablation

目的研究起源于主动脉窦与二尖瓣环交界处(AMC)室性心律失常的心电图特点及射频消融。方法观察6例起源于AMC的室性心律失常患者心电图特征及射频消融。结果 41例室性心律失常患者成功完成射频消融并且证实其起源部位,其中6例起源于AMC。仅有起源于AMC的室性心律失常心电图表现为右束支传导阻滞,QRS波电轴右偏,V1～V6导联中见到R或Rs波形,下壁导联振幅较高,Ⅰ导联呈Rs或rs形,RⅡ/RⅢ<1。三维激动扩布图可见始于AMC的波阵扩布,随后沿AMC传导至主动脉根部及左室,成功靶点消融时间短于左、右室流出道室性心律失常。结论室性心律失常时V1～V6出现R或Rs波形提示其起源于AMC,射频消融治疗安全、有效。

Objective The purpose of this study was to examine the electrocardiogram and electrophysiological characteristics of ventricular arrhythmias（VAs） arising from the aortomitral continuity（AMC）.Methods We studied 6 patients with idiopathic VAs arising from the AMC and the effect of radiofrequency catheter ablation.Results Out of 41 patients,the origin determined by the successful ablation site was AMC in six.A R or Rs pattern in leads V1-V6 with either right bundle branch block and an inferior QRS axis morphology was observed only in the VAs with an AMC origin,The amplitude of the R wave in the inferior leads were higher than any site,a Rs or rs pattern was observed in lead I and RⅡ/RⅢ1.The activation map revealed that the activation propagated wave front from the AMC towards aortic root and to the left ventricular.Conclusion This study revealed that a R or Rs pattern in leads V1-V6 suggests a site of origin at the AMC.Radiofrequency catheter ablation could be effectively and safely for VAs arising from the AMC.