反复无休止室性心动过速的动态心电图监测与研究

Monitoring and study of DCG on junctional ectopic ventricular tachycardia

目的探讨反复无休止室性心动过速(室速)的动态心电图(dynamic electrocardiogram,DCG)特点。方法收集昆明医科大学第二附属医院确诊为无休止性室速18例患者的DCG资料,根据临床诊断、心内电生理、DCG的室速特点,将患者分为两组:特发性室速(IVT)组共10例,年龄(45.00±12.83)岁;心肌病组共8例,年龄(58.86±11.39)岁。所有患者行24 h DCG监测,对室速发作总的时间、阵次、室性心搏数,频率及QRS波形态进行分析研究。结果所有患者在室速发作中持续时间占总监测时间的11.2%～30.5%;室速心搏次数占总心搏的13.2%～26.4%。IVT组中室速起源于右心室流出道7例,左心室流出道2例,左后间隔分支区域1例。与心肌病组比较,IVT组年龄偏轻,室速发作时心室率偏慢,差异有统计学意义(P<0.05);且室速持续时间长。IVT组最长一阵室速发生持续时间>30 s有8例(80%),扩张型心肌病组无1例发生。结论根据12导联DCG室速发作时间长短,可对反复无休止室速进行诊断,且通过室速发作时QRS波特点可初步判断其起源部位,对指导临床,尤其是射频消融治疗起到一定的作用。

Objectives To investigate the dynamic electrocardiogram （DCG） features on junctional ectopic ventricular tachycardia （VT） and achieve the valuable clinical data. Methods According to clinical diagnosis, electrophysiology and VT features, 18 cases＇ DCG data of junctional ectopic VT from the Second Affiliated Hospital of Kunming Medical College were divided into two groups： idiopathic ventricular tachycardia group （IVTG） [ （45.00±12.83）years, n= 10 ] ; eardiomyopathy group （CG） [ （58.86± 11.39） years, n=8 ]. All patients were monitored by DCG for 24 h. Duration, frequency, ventricular beats, ventricular rates and QRS complex on VT were analyzed. Results In all cases, VT duration took up 11.2%-30.5% of total monitoring time, and VT beats took up 13.2%-26.4% of total heart beats. In IVTG group, 7 RVOT-IVT, 2 LVOT-IVT and 1 left posterior interventricular septum were estimated. Compared with CG group, patients were significantly younger, ventricular rates on VT were significantly slower （P〈0.05） and VT duration was longer in IVTG. Conclusions Junctional ectopic ventricular tachycardia can be diagnosed based on the length of 12-1ead DCG ventricular tachycardia attack, and by the onset of ventrieular tachycardia, QRS characteristics can initially determine the origin. This is critical for guiding clinical therapy, especially in radiofrequency ablation.