采用Liwen术式射频消融治疗肥厚型梗阻性心肌病异常Q波的改变及其机制

Mechanism of abnormal Q wave formation in hypertrophic obstructive cardiomyopathy

目的探讨肥厚型心肌病体表心电图(ECG)异常Q波形成的机制。方法纳入2016年6月至2020年3月在空军军医大学西京医院肥厚型心肌病诊治中心接受Liwen术式治疗的肥厚型梗阻性心肌病(HOCM)患者172例,对存在异常Q波的28例患者术前、术后1周ECG,行心率、12导联Q波时限及振幅、RV5+SV1振幅、碎裂QRS波计数、PR时限、电轴的测量及分析。结果与术前比较,术后1周心率、Q波在Ⅰ、Ⅱ、aVL、V3、V4、V5、V6导联时限,Q波在Ⅰ、Ⅱ、aVL、aVF、V3、V4、V5、V6导联振幅,PR时限、RV5+SV1振幅之和、碎裂QRS波的计数较术前均显著性减小;患者电轴、Q波V1、V2导联时限和振幅术前、术后无显著性变化。结论异常Q波形成可能是由于室间隔增厚引起的自左向右的心室初始除极向量增大所致。

Objective To investigate the mechanism of abnormal Q wave in electrocardiogram(ECG) of hypertrophic obstructive cardiomyopathy(HOCM). Methods Twenty-eight HOCM patients who were treated with Liwen operation between June 2016 to March 2020 in Hypertrophic Cardiomyopathy Center, Xijing Hospital of Air Force Medical University, were enrolled and their ECG parameters were analyzed retrospectively, before and 1 week after operation. Results Compared with preoperative, heart rate and Q wave duration in leads Ⅰ, Ⅱ, aVL, V3, V4, V5 and V6, amplitudes of Q waves in leads Ⅰ, Ⅱ, aVL, aVF, V3, V4, V5 and V6, PR duration, sum of RV5 + SV1 amplitudes, and count of fragmented QRS waves were significantly decreased after operation;axis, lead V1, V2 and amplitude of Q wave had no significant changes before and after operation. Conclusion The formation of abnormal Q wave may be due to the increase of initial depolarization vector from left to right caused by ventricular septum thickening.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(1):12-17]