心室流出道来源特发性室性早搏的临床特点分析

An analysis of idiopathic premature ventricular contraction from right ventricular and left ventricular outflow tract

目的:探讨左右心室流出道来源的特发性室性早搏(premature ventricular contraction,PVC)的临床和消融手术的特点。方法:选择于我院成功行射频消融术且为心室流出道来源的特发性PVC患者35例,分析比较左心室流出道(LVOT)、右心室流出道(RVOT)来源的PVC在性别、年龄、体表心电图、消融手术等相关指标上的差异。结果:LVOT来源的PVC患者在V1导联的R波显著高于且宽于RVOT来源者[(0.65±0.45)mV比(0.16±0.13)mV,P<0.001;(96.80±46.65)ms比(47.93±27.82)ms,P<0.001],S波显著低于并短于RVOT来源者[(0.66±0.66)mV比(1.06±0.42)mV,P=0.03;(45.20±34.56)ms比(89.60±19.31)ms,P<0.001],V3导联的R波显著高于RVOT来源者[(1.71±0.63)mV比(0.62±0.26)mV,P<0.001]、Ⅰ导联的S波显著高于且宽于RVOT来源者[(0.33±0.21)mV比(0.07±0.08)mV,P<0.001;(65.24±41.40)ms比(27.52±30.42)ms,P=0.004]。RVOT来源的PVC患者消融手术时间显著短于LVOT来源者[(1.65±0.90)h比(2.30±0.84)h,P=0.04]。结论:LVOT来源与RVOT来源的特发性PVC患者在体表心电图及消融手术等相关指标上存在差异,对于消融术前诊断及治疗有一定指导意义。

Objective： To investigate the features of idiopathic premature ventricular contractions （PVCs） from left and right ventricular outflow tract. Methods： Thirty-five idiopathic PVCs from outflow tract patients successfully undergone catheter radiofrequency ablation were enrolled. The data concerning sex, age, ECG, and parameters of ablation procedure in PVCs from left oulflow tract and right outflow tract were compared and retrospectively analyzed. Results： PVCs from left ventricular outflow tract （LVOT） had higher amplitude and longer duration of R wave than that from right ventricular outflow tract （RVOT） in lead V1 （0.65±0.45） mV vs （0.16±0.13） mV, P〈0.001 ;（96.80±46.65） ms vs （47.93± 27.82） ms, P〈0.001, while S waves were lower in amphtude and shorter in duration （0.66±0.66） mV vs （1.06±0.42） mV, P=0.03; （45.20±34.56） ms vs （89.60±19.31） ms, P〈0.001. R waves in lead V3 had higher amplitude in PVCs from LVOT than that from RVOT（1.71±0.63） mV vs （0.62±0.26） mV, P〈0.001. S waves in lead I had higher amplitude and longer duration for PVCs from LVOT than that from RVOT （0.33±0.21） mV vs （0.07±0.08） mV, P〈0.001; （65.24±41.40） ms vs （27.52±30.42） ms, P=0.004. The duration of ablation procedure in RVOT was shorter than that in LVOT （1.65±0.90） h vs （2.30±0.84） h, P=0.04. Conclusions： There are significant differences between PVCs from left and right ventricular outflow tract in surface electrocardiogram and duration of ablation procedures, which is useful for guiding catheter radiofrequeney ablation procedure.