老年人器质性心脏病室性早搏的心电图特点

目的 探讨老年人器质性心脏病室性早搏的特点。方法 对照分析了132例老年人器质性心脏病组引起的室性早搏及94例老年非心脏病组（对照组）室性早搏的心电图特点。结果 老年心脏病组室性早搏起源于左室98例，起源于右室34例；对照组起源于左室20例，起源于右室74例。老年人心脏病组室性早搏QRS波振幅〈20mV者占67．4％，时限〉0．12s者占77．3％，有切迹或呈错折波占87．1％。与对照组比较有显著差异（P〈0．05）。结论 老年人心脏病室性早搏多起源于左室，QRS波振幅〈20mV，时限〉0．12s，形态有切迹或错折波。     

起源于右室流出道间隔部特发性室性早搏心电图及心电向量图研究

目的：探讨经射频消融证实的起源于右室流出道间隔部的特发性室性早搏（室早）的心电图特征及心电向量图特征。方法采用 CARDIO-View 心电工作站收集并分析14例经射频消融术证实为右室流出道间隔部特发性室早患者的12导联心电图及 Frank 导联心电向量图参数。结果起源于右室流出道间隔部的特发性室早呈类左束支阻滞图形。12导联心电图胸导联移行指数≥0的有12例（85．7％）,V2导联 R 波时限指数＜50％的14例（100％）, V2导联 R／S 波振幅指数＜30％的有13例（92．9％）,SV2／RV3指数＞1．5的有12例（85．7％）。心电向量图特征为：QRS 环运行方向在 F 面呈 CW 和 CCW 的各有5例（35．7％）,H 面呈 CCW的有10例（71．4％）,S 面均呈 CW（100％）;起始0．04 s,QRS 环振幅逐渐增大,QRS 环方位大部分指向左前下;0．01～0．04 s 向左向量逐渐增加,向前向量逐渐减少;QRS 环最大向量及大部分面积位于左下后。结论心电图对起源于右室流出道间隔部的室早定位诊断具有较高的准确率。起源于右室流出道间隔部的室早有典型的心电向量特征。     

特发性室性心动过速激动起源部位分区的临床研究

应用体表心电图对特发性节性心动过速（IVT）激动起源点进行分区、定位研究。将心室分为4个区11个部位。Ⅰ区即左室间隔,高、小、低3个那位;Ⅱ区即右主流出道,上、中、下和前后6个部位;Ⅲ区即注定游离壁;Ⅳ区即右室游离壁。20例（除外器质性心脏病）室上性心动过速射频消融成功后,大头导管在分区内起搏并记录12导联起搏心电图,据其特点总结出IVT起源的诊断标准。再根据诊断标准对39例消融成功的IVT病例进行IVT起源判断。结果：右室流出道IVT根据Ⅰ导联QRS波群形态特点分前后,胸前导联R波移行部位分上下。右室游离壁IVT表现为完全性左来支阻滞图形、电轴左偏。左定IVT根据电轴左偏的程度判定IVT起源部位。体表心电图诊断标准除对起源于左室中位间隔IVT诊断的灵敏度（50％）较低外,其余部位诊断的灵敏度、特异度和符合率均较高（75％～100％）。提示体表心电图对IVT起源点的定位有较高的预测价值。     

右室流出道起源与主动脉窦起源室性早搏的分析

目的 探讨右室流出道起源与主动脉窦起源室性早搏心电图的主要区别.方法 回顾分析因频发室性早搏,心电图室性早搏胸前导联呈左束支传导阻滞,Ⅱ、Ⅲ、aVF导联QRS主波向上,行射频消融成功的患者126例,分为右室流出道（RVOT）起源组66例,主动脉窦（ASC）起源组60例.结果 V1、V2导联R波时限指数和R/S波幅指数ASC组高于RVOT组.胸前导联移行区指数RVOT组高于ASC组.ROC曲线分析胸前导联移行区指数鉴别室性早搏起源有较高价值.结论 心电图呈左束支传导阻滞且Ⅱ、Ⅲ、aVF导联QRS主波向上的室性早搏,分析V1、V2导联R波时限指数、R/S波幅指数和胸前导联移行区指数可判断RVOT起源与ASC起源,指导射频消融治疗.     

S_(V2)/R_(V3)指数对室性心律失常定位诊断的研究

目的探讨S_(V2)/R_(V3)指数与QRS波时限和QRS波方向定位诊断室性早搏或室性心动过速起源部位。方法应用S_(V2)/R_(V3)指数定位诊断室性早搏或室性心动过速起源部位的240例患者组(观察组)和应用传统的QRS波时限和QRS波方向定位诊断室性早搏或室性心动过速起源部位的240例患者组(对照组)对比分析。结果观察组中S_(V2)/R_(V3)比值≤1.5mV提示室性早搏或室性心动过速起源于左室流出道者124例(51.66%)和S_(V2)/R_(V3)比值1.5mV提示起源于右室流出道者116例(48.33%),p0.05。对照组中QRS波群时限≥0.12s,I、V_5、V_6导联QRS波群呈R型,V_1、V_2导联QRS波群呈r S型,Ⅱ、Ⅲ、aVF导联主波向上,室性早搏或室性心动过速起源于右室者122例(50.83%),QRS波在Ⅱ、Ⅲ、aVF导联主波向上,V_1～V_6导联主波向下或Ⅱ、Ⅲ、a VF导联主波向下,V_1～V_6导联主波向上,室性早搏或室性心动过速起源于左室118例(49.16%),p0.05。两组中各35例接受射频消融术终止室早或室速:观察组25例(80.00%),对照组15例(42.85%),p0.01。结论应用S_(V2)/R_(V3)比值诊断室性早搏或室性心动过速的起源部位优于传统的QRS波时限或QRS波方向诊断室性早搏或室性心动过速的起源部位,对射频消融术的筛选具有实用价值。     

173例室性早搏心电图分析

目的 通过定位性分析，探讨功能性与器质性室性早搏(PVS)的区别。方法 将173例分为2组：A组为有器质性心脏病者，B组为无器质性心脏病者，分别描记12导联同步心电图。结果 起源于左室：A组58例、B组25例；起源于右室：A组25例、B组65例。A组PVSORS时限≥0．16s者占14．46％，有切迹者占66．27％，ST等电位线者占61．45％，T波对称者占57．83％，T波与主波方向相反者占21．69％。与B组对比有显著差异。结论 病理性PVS多起源于左室，QRS≥0．16s，QRS波形态粗钝有切迹，有ST-T改变，呈多源性、多形性或伴有短阵室速(VT)．     

右室流出道不同部位起搏体表心电图的形态特征研究

右室流出道 (RVOT)是一个相对较大的区域 ,事先定位这一区域内心律失常的起源部位有助于指导射频消融治疗。为评估根据体表 1 2导联心电图定位起源于RVOT不同部位的心律失常 ,选择 90例无器质性心脏病的室上性心动过速患者 (57例房室折返性心动过速、33例房室结折返性心动过速 )进行研究。将RVOT分为游离壁和间隔 ,按距肺动脉瓣的距离由近至远再分上、中、下三部 ,共 6个区。成功进行射频消融后 ,于RVOT不同部位进行起搏 ,并同时记录 1 2导联体表心电图。结果 :在间隔和游离壁起搏时 ,Ⅰ、aVL导联表现为特征性变化。间隔部起搏时Ⅰ导联QRS波形态多变 ,aVL导联QRS波主要呈QS型 ,QRSⅠ/QRSaVL<1 ;在游离壁起搏时 ,Ⅰ导联QRS波主要呈R型 ,aVL导联QRS波形态多变 ,QRSⅠ/QRSaVL>1。Ⅰ、aVL导联QRS波形态特征对判断游离壁和间隔具有较高的特异度和灵敏度。在RVOT上、中、下位起搏时 ,V3导联呈特征性变化 ,分别主要呈R、RS(R/S >1 )、rS(r/S <1 )型。V3导联QRS波形态特征对判断RVOT的上、中、下位具有较高的特异度和灵敏度。结论 :可根据体表心电图图形特征 ,定位RVOT起源的心律失常部位     

射频导管消融治疗的特发性室性心律失常心电图特征分析

目的：探讨不同起源的特发性室性期前收缩（PVCs）和（或）室性心动过速（VT）的心电图特征,提出鉴别流程。方法根据射频导管消融PVCs/VT有效靶点或心室最早激动点的X线胸片进行定位,分析不同起源PVCs/VT的12导联心电图QRS波群。结果828例接受导管消融,580例起源于右心室,248例起源于左心室,左、右心室起源者胸导联移行指数＜0的分别占97.58%及7.24%;左和右心室流出道起源者下壁导联多数呈R型,V1上,多数右心室流出道起源者呈rS型,右室间隔起源呈QS型,主动脉瓣上起源者常呈rS或RS型;下壁导联上,左前分支起源者常呈qR型,左后分支起源者常呈rS型。结论结合体表心电图胸导联移行指数、下壁导联和V1上的QRS波群特征可初步判断特发性PVCs/VT的起源部位。     

非接触球囊标测系统指导下右室流出道室性期前收缩导管消融疗效及体表心电图应用价值

目的:探讨非接触球囊标测系统指导下右室流出道室性期前收缩（室早）导管消融疗效及体表心电图应用价值。方法:术前根据同步12导联体表心电图室早的形态特征初步判断室早起源部位,对58例药物治疗无效的顽固性室早患者进行导管射频消融治疗,其中26例采用传统标测法,32例采用非接触球囊标测法（Ensite三维标测法）。结果:①非接触球囊标测法与传统标测法相比较,成功率高（100% vs. 81%）、复发率低（3% vs. 19%）,X线曝光时间短［(3.6±1.4)min vs.(32±12)min］;②标测和消融结果显示30例患者室早起源于右室流出道间隔部,其中7例起源于前间隔,9例起源于中间隔,14例起源于后间隔。22例患者室早起源于右室流出道游离壁,其中7例起源于前游离壁,4例起源于中游离壁,11例起源于后游离壁。体表心电图特征对判断室早起源部位具有较高的灵敏度、特异度和准确度。结论:非接触球囊标测系统指导右室流出道室性心律失常射频消融安全有效,仔细分析心电图室早QRS波形态特征有助于判定室早起源部位,并缩短手术时间。     

流出道起源室性早搏心电图特征及其对射频消融靶点的判断价值

目的：研究室性早搏（室早）的心电图特征及对流出道室早的定位价值。方法回顾68例成功消融的右室流出道（RVOT）和左室流出道（LOVT）室早患者的图形,测量胸前导联 R／S值、R／S 转换部位、V2导联 QRS 波时限、V2导联 R 波振幅指数和 R 波时限指数,探讨其与射频消融靶点的关系。结果54例起源于 RVOT 与14例起源于 LVOT 的室早患者一般情况无显著差异。RVOT 室早比 LVOT 室早时限更短（P ＜0．05）,R／S 转换在 V1～V2导联的有12例,其中LVOT 11例,特异性91．67％,敏感性78．57％;转换在 V3导联的24例,其中 RVOT 21例,特异性87．50％,敏感性38．89％;转换在 V4～V6导联的为32例 RVOT 患者,特异性100％,敏感性59．26％;V2导联 R 波振幅指数和时限指数对 RVOT 室早的定位价值低于对 LVOT 室早的定位价值（P ＜0．05）。结论R／S 转换在 V2或 V2之前对 LVOT 的诊断价值大;转换在 V4或 V4之后对 ROVT 的诊断价值大;对于 R／S 转换在 V2～V3导联时,V2导联 QRS 波时限、R 波时限指数和 R 波振幅指数三个指标对确定室早的起源部位具有重要的价值。     

Sites of origin of ventricular premature beats in patients with and without cardiovascular disease evaluated by body surface mapping

The site of origin of ventricular premature beats (VPBs) was estimated by QRS maps and its distribution in two patient groups was studied. VPB origin was determined by comparing the body surface map of VPBs with that during electrical stimuli applied at various sites of the ventricle. Subjects were 100 patients without obvious underlying cardiovascular disease (Group N) and 289 patients with various heart diseases (Group D). Nine sites of origin of VPB were identified. In group N, VPBs of right ventricular origin were noted in 69%, those of left ventricular origin in 6%. There was a relatively high incidence of VPBs with foci estimated to be the divisions of the left bundle branch, and the age of patients with these VPBs was young. In Group D, VPBs of left ventricular origin showed a higher incidence (34.6%) and those of right ventricular origin a lower incidence (41.2%) than those in group N. The data suggest that VPBs originating from the apex and base of the ventricle strongly indicate the presence of basic heart disease and that VPBs originating in or near the divisions of the left bundle branch in younger subjects do not necessarily indicate cardiac disease.     

Identification of the site of origin of ventricular premature beats and its activation sequence by body surface isopotential map

To determine the more exact site of origin of ventricular premature beats (VPBs), body surface maps were recorded in 28 patients, aged 15 to 71 years (mean 52) with no cardiac disorders. The site of origin of VPBs was determined from 1) sequential isopotential maps, 2) ventricular activation time (VAT) map and 3) on the basis of maps during pacemaker stimulation at different ventricular areas. To get a three dimensional idea regarding the progression of the ventricular activation front, zero plane was constructed in the human torso by supposing the plane which includes zero potential line on body surface at each instance of ventricular activation. Unipolar lead electrocardiograms were recorded from 85 lead points over the body surface to obtain maps. The site of origin was determined to be from right ventricle in 15 patients, from top of interventricular septum in 10 patients, and from left ventricle in 3 patients. Of 15 patients with right ventricular premature beats, 3 were from outflow region, 4 were from posterobasal region, 6 were from inflow region and 2 were from apical region. Of 3 patients with left ventricular premature beats, 2 were from posterobasal region and 1 was from high lateral region.     

QRS波第一峰时限诊断期前宽QRS波的价值

目的探讨应用QRS第一峰时限对期前宽QRS波的鉴别诊断价值。方法分别测量已确诊的106例房性早搏并室内差异传导和593例室性早搏心电图的Ⅱ导联QRS第一峰时限,以检测该指标的符合率。结果右心室早搏、左束型室内差异常传导、左心室早搏和右束支型室内差异传导诊断符合率分别为78.91%、35.00%、76.34%和96.51%。结论 QRS第一峰时限对右束支型室内差异传导与左心室早搏的鉴别诊断有重要的临床意义。应用同步12导联法可提高QRS第一峰时限诊断的准确性。     

Study on the relationship between myocardial ischemia assessed by 24-hour ambulatory electrocardiogram and ventricular premature beat originating from different positions in older adults

BackgroundMyocardial ischemia is a common reason of ventricular premature beat, and it plays an important role in arrhythmia in older adults. We could often see the report about the diagnosis and radiofrequency catheter ablation of ventricular arrhythmia from the right ventricular outflow tract, Haissaguerre et al. (2002) [1], Miyamoto et al. (2010) [2], Nakagawa et al. (2008) [3], Zhu et al. (1995) [4]. However, no study to date has examined the relation of myocardial ischemia and ventricular premature beat originating from different positions. In this article, we studied the incidences of myocardial ischemia of ventricular premature beats originating from different positions in older adults.MethodsWe located the original positions of ventricular premature beats according to the shape of the wide and malformed QRS waves in 12 leads synchronizing ECG. We used synchronism 12-lead ambulatory 24 hour electrocardiograms to examine 531 aged patients with ventricular premature beats, calculated the incidences of myocardial ischemia of the ventricular premature beats originating from different positions.ResultsThe incidence of myocardial ischemia of ventricular premature beats from the right ventricular outflow and the left ventricular outflow were 52.31% and 51.42% respectively. The incidence of myocardial ischemia of ventricular premature beat from the right ventricle anterior wall and the left ventricle anterior wall were 53.57% and 73.47% respectively. The incidence of myocardial ischemia of ventricular premature beat from the right ventricular apex and the left ventricular apex were 55.10% and 74.42% respectively. The total incidence of myocardial ischemia of right ventricular premature beats and left ventricular beats were 52.92% and 61.65% respectively.ConclusionsThe total incidence of myocardial ischemia of left ventricular premature beats was higher than that of right ventricular premature beats. The highest incidence of myocardial ischemia of ventricular premature beats was that from the left ventricular apex and anterior wall. The incidence of myocardial ischemia of ventricular premature beats was more than 50% in older adults.     

Left ventricular blood flow dynamics caused by ventricular premature contraction: pulsed Doppler echocardiographic study

Cardiac function at the time of ventricular premature contractions (VPC) is influenced by the coupling interval or the site of those origin. Clinical and experimental studies of the effects of VPC on intracardiac pressure dynamics have been performed; however, little is known about left ventricular blood flow dynamics. This study was attempted to determine the characteristics of blood flow dynamics in respect to the site of origin of VPC using pulsed Doppler echocardiography. The subjects consisted of 18 cases with VPC but without apparent organic heart disease. Seven cases had VPCs with a left bundle branch block pattern suggesting possible origin in the right ventricle. The other 11 cases had VPCs with a right bundle branch block pattern indicating the left ventricular origin. With the probe in the apical position, the blood flow patterns of the left ventricular outflow, central and inflow tracts were examined. The results were as follows; 1. Except for one case with shortened coupling interval, all six cases with VPCs originated from the right ventricle showed preservation of left ventricular ejection flow. 2. In two of the three cases with VPC which originated from the left ventricle and with left axis deviation, systolic flow in the left ventricular central area showed "back flow" to the apex. Ejection flow at the outflow tract was markedly diminished or disappeared in all three cases. 3. In all eight cases with VPC which originated from the left ventricle and with right axis deviation, ejection flow was slightly disturbed both in the left ventricular outflow and in the central area. 4. Ejection flow volume assessed by velocity integral indicated similar dynamics as did the ejection flow velocity. 5. In left ventriculography, asynchrony due to dyskinetic motion of the anteroapical wall was observed at the times of VPCs with left axis deviation. In conclusion, the patterns of left ventricular ejection flow dynamics depend on the site of origin of VPCs. This disturbed flow is more apparent in VPCs originating from the left ventricle compared to the right ventricle. This is especially true in cases with left axis deviation, in which VPCs arise from the posterior site of the left ventricle.     

Ensite非接触标测系统在室性心律失常患者射频消融中的应用

目的探讨Ensite系统标测室性心律失常的方法,并评价其指导射频消融的有效性和安全性。方法入选症状性室性期前收缩(室早)或室性心动过速(室速)患者98例,年龄(42±16)岁,其中男43例,女55例。经外周血管进非接触多极球囊导管至右心室或左心室三维重建心腔。心室激动时根据虚拟单极电位的等电位图,结合起搏和激动标测对起源点和突破口及优势传导通道进行消融。结果消融即时成功率95%(93/98)。起源于右心室流出道占96种,间隔部和游离壁各82、14种,起源于其他不典型部位21种,三尖瓣环8种。起源后传导突破呈快反应点爆发方式占78%(91/117),采用点消融覆盖相近的起源点和突破口;呈慢反应突破方式占22%(26/117),采用线性或片状消融策略。随访(6±3)个月,3例复发,1例经再次消融成功。结论 Ensite心内非接触式标测系统用于室性心律失常的三维标测有效安全。室速或室早自最早起源点后经优势传导通道向突破口传导有两种传导方式。     

特发性室性心动过速及室性期前收缩的射频消融治疗

目的探讨射频导管消融(radiofrequency catheter ablation,RFCA)治疗特发性室性心动过速(idiopathic ventricular tachycardia,IVT)和室性期前收缩(premature ventricualr contraction,PVC)可行性、必要性和疗效。方法回顾性分析16例IVT、PVC患者采用激动顺序标测和起搏标测法确定室性心动过速(ventricular tachycardia,VT)、PVC的起源部位并行RFCA治疗的资料。结果 3例IVT中2例起源于左室间隔部左后分支的蒲肯野系统,1例起源于右心室流出道(right ventricular outflow tract,RVOT)游离壁,同时合并另一种游离壁起源的PVC,3例消融均成功,1例复发。13例PVC中7例起源RVOT间隔部,3例起源于RVOT游离壁,1例同时存在两种形态PVC(分别起源于ROVT间隔部和游离壁),2例起源于左心室流出道,13例消融成功,1例复发。结论 RFCA治疗IVT及特定部位的PVC是安全、有效且成功率高的一种方法。     

Morphology of ventricular premature beats as an aid in the electrocardiographic diagnosis of myocardial infarction

To determine whether morphologic analysis of ventricular premature beats (VPBs) can aid in the electrocardiographic diagnosis of myocardial infarction (MI), 12-lead electrocardiograms were evaluated in 760 consecutive patients who underwent cardiac catheterization, and 2-minute multiple-lead rhythm strips were evaluated in 515 of these patients. VPBs occurred in 58 patients; 21 had prior MI diagnosed by regional akinesia or dyskinesia on left ventricular cineangiography. Standard criteria were used to diagnose prior MI from the sinus beats of the electrocardiogram. Infarction was diagnosed from the morphology of a VPB when it had a QR or QRS pattern with Q wave greater than or equal to 0.04 second. Morphologic analysis of VPBs had a low sensitivity (29%) but high specificity (97%) and high predictive value (86%) for the diagnosis of MI. Sinus beats diagnosed MI with higher sensitivity (52%, and 69% if patients with left bundle branch block and left ventricular hypertrophy were excluded from analysis) than VPB morphologic analysis (p less than 0.05), but with similar specificity (97%) and predictive value (92%). Two patients with angiographic MI had no MI according to standard electrocardiographic criteria, but did have an MI manifest by VPB morphologic analysis. Despite low sensitivity, analysis of the morphology of VPBs may be useful for the diagnosis of MI when the morphology of sinus beats is not diagnostic. Therefore, VPB analysis is complementary to the standard electrocardiographic diagnosis of MI.