起源于主动脉瓣和二尖瓣结合部的特发性室性心律失常心电图特征及射频消融治疗

Electrocardiographic Characteristics and Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmia Originating from the Aortomitral Continuity

目的:观察起源于主动脉瓣和二尖瓣结合部(AMC)室性早搏(室早)/室性心动过速(室速)的心电图特征,探讨此类心律失常射频消融治疗效果。方法:常州市第一人民医院心内科2017年09月至2019年01月143例室性心律失常患者行电生理检查(EPS)和射频消融术(RFCA),其中7例患者被确诊为AMC起源的室早/室速并进行消融,行十二导联心电图形态分析。结果:对7例AMC起源室早/室速的心电图行进一步分析,特点如下:V1导联呈R或Rs形,V2-V4导联均为Rs波,V5、V6导联呈R波,胸前导联R波移行于V1导联。I导联呈rs型,下壁导联均为高大R波,RII ≥ RIII,R波降支有切迹。AVR及AVL导联为QS型。其中6例室早/室速消融成功,均起源于AMC,1例室早消融失败。结论:起源于AMC处室早/室速有显著的心电图特征,掌握其心电图表现有助于术中快速精确定位,提高消融成功率。

Objective:To observe the electrocardiogram(ECG)characteristics of premature ventricular con-tractions(PVCS)/ventricular tachycardia(VT)originating from the aortomitral continuity(AMC),and to explore the efficacy of radiofrequency catheter ablation(RFCA)in such patients.Methods:Electrophysiological study(EPS)and RFCA were performed on 143 patients with PVC/VT in Changzhou first people’s hospital from September 2017 to January 2019.Among them,7 patients were diagnosed as PVC/VT originating from AMC and received ablation.Results:The 12-lead ECG patterns of AMC originated PVC/VT were characterized by:R or Rs wave in lead V1,R/S transition zone in V1 lead,Rs wave in lead V2-V4,rs wave in lead I,high R wave in lead II,III,aVF with R wave fall section incised,QS wave in both lead aVR and aVL.6 cases were treated successfully by RFCA,and those PVC/VT all originated from AMC.RFCA failed in one case with PVC.Conclusion:PVC/VT originating from AMC has distinct characters in ECG.12-leads ECG analysis is a helpful tool in determining the exact origin of these PVC/VT and then improving the rate of successful ablation.