致心律失常性右室心肌病室性心动过速伴左束支传导阻滞的特点

The profiles of ventricular tachrrhythmias with left bundle branch block in patients with arrhythmogenic right ventricular cardiomyopathy

目的分析致心律失常性右室心肌病(ARVC)患者的室性心动过速(室速)伴左束支传导阻滞(LBBB)的心电图特点。方法收集ARVC患者40例,对每例患者行12导联心电图、Fontaine导联心电图和平均信号心电图检查,并与20例诊断为起源于右室流出道(RVOT)的特发性室速患者作比较。结果 ARVC患者出现症状的年龄为(32.2±12.7)岁,男性患者的比例较高(85.0%),最常见的症状是心悸(82.5%),其次是胸痛(25.0%)和晕厥(22.5%)。T波倒置(75.0%)是最常见的心电图表现,随后是QRS波时限延长(45.0%)和Epsi-lon波(35.0%)。伴LBBB的室速有28例(70.0%)。T波倒置(53.0%)仍是ARVC患者LBBB室速的主要心电图特征,其中主要是V1～V3或V1～V4导联出现T波倒置,晚电位阳性为(50.0%)。ARVC室速患者Ⅰ导联和V1导联的QRS波时限大于RVOT室速患者(P<0.05),且胸导联的移行较RVOT室速患者晚(P<0.05)。结论ARVC患者LBBB室速与RVOT室速的心电图特征有差别。

Objective To evaluate the features of ventricular arrhythmias with left bundle branch block in arrhythmogenic right ventricular cardiomyopathy（ARVC） patients.Methods Forty subjects fulfilling the modified task force criteria and 20 patients right ventricular outflow tract tachycardia were included.Information on clinical presentation,12-lead electrocardiography and Fontaine electrocardiographic were evaluated.Results The mean onset age was（32.2 ± 12.7） years,as male in predominance（85.0%）.Palpitation was the most frequent symptom（82.5%）,followed by chest pain（25.0%） and syncope（22.5%）.T-wave inversion was the most common presenting abnormality on resting 12-lead ECG（75.0%）,followed by localized QRS prolongation（45.0%） and epsilon waves（35.0%）.Ventricular tachycardia with left bundle branch block morphology was subsequently documented in a 28 subjects（70.0%） during a study period.T-wave inversion（53.0%） in V1 ～ V3 leads was the most common presenting abnormality in patients of ventricular tachycardia with left bundle branch block morphology,followed by late potentials on signal-averaged ECG.Comparing with right ventricular outflow tachycardia patients,significantly prolonged QRS duration was observed（P〈0.05）,with significantly later precordial transition in V6 lead（P〈0.05） in ARVC patients.Conclusion There were significantly differences between right ventricular outflow tract arrhythmias originating from ARVC and right ventricular outflow tract tachycardia patients.