特发性左心室性心动过速射频导管消融后体表心电图的改变

Surface 12-lead electrocardiogram alteration after radiofrequency catheter ablation in patients with idiopathic left ventricular tachycardia

目的观察特发性左心室性心动过速患者射频导管消融后体表心电图的变化及其可能机制。方法对35例行射频导管消融的特发性左后分支室性心动过速患者,比较术前术后12导联体表心电图,并作随访6个月时体表心电图的对比观察。结果全组35例患者的消融均取得成功。其中6例术后Ⅱ、Ⅲ、aVF导联新出现q波,R波电压较前增高;Ⅰ、aVL导联的s波加深,QRS波群电压增加。并伴有QRS波群电轴改变,均未见ST段改变。出现心电图改变与未见心电图改变患者间消融中放电时间和消融靶点数无明显差异。在随访期间所有患者的体表心电图QRS波群和ST段未见动态改变。结论特发性左心室性心动过速患者射频导管消融后体表心电图出现的左后分支不同程度阻滞的图形改变可能因术中左后分支的分支及浦肯野纤维损伤引起。

Objective To observe surface ECG changes after radiofrequency catheter ablation (RFCA) in patients with idiopathic left ventricular tachycardia (ILVT) and to analyze possible mechanisms. Methods In 35 cases with ILVT, RFCA was performed in left ventricle posterior septum, surface ECG before and after RFCA were compared. All patients were followed up 6 months. Results RFCA in all patients was succeeded. In 6 patients, after RFCA procedure lead II, III, aVF had a significant 'q' wave and lead I, aVL had 's' wave compared with ECG before RF. There was no significant difference in duration of RF energy delivered between patients having ECG alteration and no ECG alteration. All of changes in surface ECG had no dynamic alteration and no ST change . Conclusion Patients with alteration in surface ECG had no myocardial infarction, and this change may be result from injury of left posterior fascicle, but in all patients who had no change of RF was effective, so we considered that might be result of different injury degree to left posterior fascicle.