儿童流出道室性心律失常不同起源部位的心电图特征

The electrocardiogram characteristics of outflow tract ventricular arrhythmias in children

目的:探讨儿童流出道室性心律失常不同起源的心电图特征。方法:分析2009年1月至2015年1月接受射频消融治疗的,84例流出道室性心律失常儿童心电图特征,包括不同导联QRS波群时限、振幅及极向。其中右室流出道起源的占60例(间隔48例、游离壁12例),左室流出道起源的占24例(左冠窦13例、右冠窦8例、无冠窦3例)。结果:右室流出道室性心律失常V1导联R波时限为(0.05±0.02)s、波振幅为(0.25±0.25)mV,S波振幅为(1.78±0.41)mV,分别对应左室流出道室性心律失常V1导联R波时限(0.08±0.03)s、波振幅(0.54±0.36)mV,S波振幅为(1.27±0.69)mV,统计学差异有显著性。右室流出道室性心律失常V2导联S波振幅为(2.69±0.91)mV,V3导联S波振幅为(2.83±0.82)mV,分别对应左室流出道室性心律失常V2导联S波振幅(1.68±0.92)mV,V3导联S波振幅为(2.03±0.59)mV统计学差异有显著性。右室流出道室性心律失常胸前导联<V3导联之后移行的占66.7%(40/60);左室流出道室性心律失常胸前导联≥V3导联之前移行的占87.5%(21/24),两者统计学差异有显著性。右室流出道间隔起源的室性心律失常Ⅱ导联R波时限为(0.14±0.02)s、Ⅲ导联R波时限为(0.14±0.03)s、aVF导联R波时限为(0.15±0.02)s;分别对应右室流出道游离壁起源的室性心律失常Ⅱ导联R波时限(0.16±0.02)s、Ⅲ导联R波时限(0.16±0.01)s、aVF导联R波时限(0.16±0.01)s统计学差异有显著性。右室流出道间隔起源的室性心律失常Ⅰ导联QRS的极性可为正或负向;游离壁起源的均为正向。右冠窦起源的Ⅰ导联QRS波的极性均为正向;左冠窦起源的均为负向。结论:掌握儿童流出道室性心律失常不同起源的心电图特征对射频消融术有一定意义。但心电图定位仅作为参考,不可依赖。

Objective:To investigate the characteristics of electrocardiogram(ECG)in children with different origins of outflow tract ventricular arrhythmias(OTVAs).Methods:To analyze the ECG characteristics of 84 children with OTVAs who received radiofrequency catheter ablation(RFCA)from January 2009 to January 2015,including 60 cases of right ventricular outflow tract(RVOT):septum/free wall(48/12)and 24 cases of left ventricular outflow tract(LVOT):13 cases from left coronary sinus(LCC),8 cases of right coronary sinus(RCC)and 3 cases from no coronary sinus(NCC).Results:V1 R wave duration(0.05±0.02)s vs(0.08±0.03)s,R wave amplitude(0.25±0.25)mV vs(0.54±0.36)mV,S wave amplitude(1.78±0.41)mV vs(1.27±0.69)mV of RVOT ventricular arrhythmias,respectively corresponding to LVOT ventricular arrhythmias,were statistical difference significantly.V2 S wave amplitude(2.69±0.91)mV vs(1.68±0.92)mV and V3 S wave amplitude(2.83±0.82)mV vs(2.03±0.59)mV of RVOT ventricular arrhythmias,respectively corresponding to LVOT ventricular arrhythmias,were statistical difference significantly.RVOT ventricular arrhythmias precordial lead transitional zone<V3 accounted for 66.7%(40/60);LVOT ventricular arrhythmias precordial lead transitional zone≥V3 accounted for 87.5%(21/24),the statistical difference was significant.RVOT septum origin of ventricular arrhythmiaⅡR wave duration(0.14±0.02)s vs(0.16±0.02)s,ⅢR wave duration(0.14±0.03)s vs(0.16±0.01)s,aVF R wave duration(0.15±0.02)s vs(0.16±0.01)s of RVOT septal origins,respectively corresponding to RVOT free wall origins were statistical difference significantly.The QRS polarity in leadⅠof RVOT septal origin was positive or negative,and the one of the free wall origin was positive.The QRS polarity in leadⅠof ventricular arrhythmias of the right coronary sinus(RCC)was positive;the one of the left coronary sinus(LCC)was negative.Conclusion:It has a certain significance for RFCA to know the characteristics of ECG from different origins of OTVAs in children.However,the ECG is only as a guide and would not be relied on.