两种非经典部位起源的室性心动过速/室性早搏的心电图特点和射频消融治疗

Electrocardiographic characteristics and radiofrequency catheter ablation of idiopathic ventricular tachycardias or premature ventricular contractions originating from the two non-classical sites

目的探讨起源于主动脉窦和三尖瓣环部的室性心动过速/室性早搏(VT/PVC)的体表心电图特点和射频消融治疗。方法根据心电图和临床症状确诊为VT/PVC患者6例,均接受心脏电生理检查和射频消融。消融成功后,结合消融靶点位置对患者体表心电图进行分析。结果 6例VT/PVC均消融成功,3例起源于主动脉窦,其中2例右冠窦,1例左冠窦;另3例起源于右心室三尖瓣环部,其中2例游离壁,1例偏间隔部。主动脉窦起源的VT/PVC心电图呈左束支传导阻滞图形且额面电轴下偏,Ⅱ、Ⅲ、aVF导联呈高耸直立的R波,胸前导联一般在V3导联之前移行,V4～V6导联呈高振幅R波,V5、V6导联一般无s波。三尖瓣环部起源的VT/PVC心电图呈左束支传导阻滞图形,Ⅰ、aVL、V5、V6导联呈高R波,Ⅱ、Ⅲ、aVF导联QRS波的极性可正可负,但三者极少同时正向,胸前导联一般在V3～V5导联发生移行。其中三尖瓣环游离壁起源的VT/PVC与间隔侧起源的相比,具有QRS波限较长、肢体导联QRS波可有切迹和胸前导联移行较晚的特点。结论与经典部位的VT/PVC相比,两种非经典部位起源的VT/PVC具有一些特殊的心电图表现。射频导管消融能够对其进行安全、有效的治疗。

Objective To investigate the electrocardiogram （ECG） characteristics and radiofrequency catheter ablation （RFCA） of ventricular tachycardias （ VTs ） or premature ventricular contractions （PVCs） originating from the aortic sinus and tricuspid annulus. Methods 6 patients with VT or PVCs diagnosed by ECG and clinical symptoms under- went electrophysiological study and RFCA in our hospital. After the successful ablations, the 12 leads ECG characteris- tics were analyzed in accordance with the location of target sites. Results All 6 patients were successfully ablated. The VT/PVCs originated from the aortic sinus in 3 patients, in which 2 arose from the right sinus and 1 from the left sinus. The VT/PVCs originated from the tricuspid annulus in the remaining 3 patients, including 2 arose from the free wall and 1 from the septal portion. The ECG pattern of the VT/PVCs originated from the aortic sinus showed a monomorphic left bundle branch block （LBBB） QRS and an inferior axis in the frontal plane, towering R-waves in leads 1I , ]II, aVF and the precordial R-wave transition before lead V3. A small S wave was not found in lead V5 or V6. The ECG pattern of the VT/PVCs originated from tricuspid annulus showed a LBBB QRS morphology, upright R-waves in leads I , aVL, V5 and V6, positive or negative QRS complex in leads II , III and aVF and the precordial R-wave transition in lead V3 - V5. Compared with the VT/PVCs originated from the septal portion of tricuspid annulus, the cases from the free wall showed some characteristics, including a greater QRS duration, ＂Notching＂ of the QRS complex in the limb lead and a later precordial R-wave transition. Conclusions VT/PVCs originating from the two non-classical sites have specific electrocardiographic characteristics, and can be safely and effectively cured by RFCA.