特发性三尖瓣环室性心律失常的心电图特征和导管消融疗效分析

The electrocardiogram characteristics and clinical results of radiofrequency ablation on idiopathic ventricular arrhythmias originating from the tricuspid annulus

目的探讨三尖瓣环特发性室性心律失常(IVAs)的心电图特征及导管消融疗效。方法对本中心在CARTO三维标测系统指导下成功行导管消融IVAs的临床资料进行回顾性分析。结果①在2011年1月至2012年12月期间,共计246例进行了三维标测指导下的导管消融术,22例IVAs(19例为室性早搏,3例为室性心动过速)起源于三尖瓣环,即本组三尖瓣起源IVAs占8.9%(22/246)。其中男14例,女12例,年龄34.5±6.8岁。15例(68.2%)起源于三尖瓣环游离壁,7例(31.8%)起源于三尖瓣环间隔部(其中3例在His束附近)。②所有22例三尖瓣环IVAs心电图为左束支传导阻滞图形以及aVL导联正向或正负双向波。游离壁起源的IVAs较间隔部起源更常存在下壁导联终末部位顿挫、胸前移行导联常在V3之后。③20例消融成功(成功率为90.9%),1例合并右束支传导阻滞。结论三尖瓣环IVAs并不少见,体表心电图有助于判断起源部位,CARTO指导下冷盐水灌注导管消融可提高手术有效性和安全性。

Objective To clarify the characteristics of electrocardiography（ECG） and the clinical value on idiopathic ventricular arrhythmias （IVAs） originating from the tricuspid annulus. Methods The characteristics of ECG and clinical results of the CARTO mapping system in the guiding of catheter ablation were analyzed in 246 patients with IVAs from January 2011 to December 2012 in our center. Results Twenty-two （8.9%） patients （ 14 males and 12 fe- males） at the age of 34.5±6.8 years had IVAs （ including 3 patients with ventricular tachycardia and 19 cases of ventric- ular premature beats） arising from the tricuspid annulus： 15 patients （68.2%） originated from the free wall of the tri- cuspid annulus and the remaining 11 （31.8% ） from the septal portion of the tricuspid annulus. A total of 22 had a char- acteristic ECG with a left bundle branch block and R of＋wave in lead aVL. ＂ Notching＂ of the QRS complex and R-wave transition beyond lead V3 was observed more often in IVAs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus （P 〈 0.05 ）. 20 cases of IVAs arising from tricuspid annulus were successfully ablated （90.9%）, and 1 case complicated by right bundle branch block at discharge. Conclusion IVAs arising from tricuspid annulus are not rare, and the detailed origin can be determined by ECG analysis and CARTO mapping system could be useful for an effective ablation for the IVAs.