特发性束支折返性室性心动过速的临床特点(附二例报道)

Clinical Characteristics and Radiofrequency Catheter Ablation of Idiopathic Bundle Branch Reentrant Ventricular Tachycardia.

通过对两例特发性束支折返性室性心动过速 (BBR VT)的临床、心电图及电生理特性进行分析 ,提出该类病人的临床特点。两例病人均无器质性心脏病的证据。例 1男性 ,VT发作最长持续达 2 7h ,体表心电图呈近似心室扑动的图形 ,心内电生理检查证实为类左束支阻滞图形 ,QRS波宽 2 6 0ms。平时体表心电图QRS波正常 ,心内电图提示HV间期延长 ,VT可稳定诱发和终止 ,存在V3 现象 ,右束支消融成功。例 2女性 ,VT发作病史 7年 ,呈无休止性VT发作 ,平时体表心电图为完全性右束支传导阻滞伴左前分支阻滞图形 ,VT可稳定诱发和终止 ,发作时其QRS波宽为 14 0ms ,呈类完全性右束支传导阻滞伴左前分支阻滞图形 ,V波前有稳定的H波 ,消融左后分支后可导致Ⅲ度房室阻滞而终止VT。结论 :束支折返性VT可见于无器质性心脏病病人 ,有独特的电生理特性 ;

To clarify clinical,electrophysiological features and radiofrequence catheter ablation of idiopathic bundle branch reentrant ventricular tachycardia(BBR VT).Two patients with BBR VT were analyzed.Both of them were excluded structural heart disease by clinical and laboratory evaluation and the antiarrthymic medicines had no effects on the VT.The male patient,whose surface ECG was normal,had an intracardiac electrogram displaying a prolonged H V interval.VT can be deduced and terminated by ventricular stimulation and V 3 phenomenon existed.The VT was successfully terminated by ablation of the right bundle branch.The female patient,whose VT was incessant,had an surface ECG with the configuration of complete right bundle branch block and leftanterior block,and the width of QRS complex was 140 ms,there was H wave prior to the V wave.The VT was terminated and cannot be deduced after ablation of the leftposterior fascicular branch.Conclusions:BBR VT can appear in patients without structural heart disease,it is one new special type of the idiopathic VT.