右室流出道室性早搏成功消融部位和心电图特征

临床上经常遇到无器质性心脏病的患者有频发室性早搏(室早),尽管室早不一定引起严重后果,长期随访观察预后良好,但可引起明显症状,且有时经药物及临床医师的解释治疗后仍难以控制相关症状。部分室早具右室流出道室性心动过速(RVOT-VT)的心电图特征,文献报道射频消融(RFCA)能有效地控制该类室早。但起搏标测仍然较困难,且费时间。本文目的在于分析右室流出道室早的多发部位,失败病例的特点及寻找对起搏标测有指导意义的心电图特征,这将有助于缩短RFCA时间,提高成功率。　　资料和方法　20例患者,男性6例,女性14例,年龄15～49岁,平均3.8…     

右心室流出道室性早搏的定位与导管消融

目的本文旨在探索判断右心室流出道室性早搏（室早）起源的新流程,以便快速、准确地找到消融靶点。方法采用非接触三维标测系统对右心室流出道室早进行标测与导管消融,并分析右心室流出道室早体表心电图特征。根据三维标测与导管消融结果,并结合先前报道的室早起源判断流程,设计新的判断室早起源流程。结果标测与消融结果显示21例患者室早起源于右心室流出道间隔部,其中5例起源于前间隔,4例起源于中间隔,12例起源于后间隔;17例患者室早起源于右心室流出道游离壁,其中5例起源于前游离壁,2例起源于中游离壁,10例起源于后游离壁;1例患者室早起源于希氏束附近。判断室早起源新流程的总阳性预测值（77．3％）较Ito等报道的73．3％、Joshi等报道的73．3％、Dixit等报道的53．8％显著提高（P〈0．05）。新流程在判断室早具体起源部位较Ito等、Joshi等与Dixit等报道的室早起源部位判断流程有较大的优势,其敏感性、特异性与阳性预测值分别为78．1％,88．9％与84．2％,Joshi等报道的流程分别为32．9％,65．8％与48．1％,Dixit等报道的流程分别为50．7％,63．9％和55．2％（P均〈0．05）。结论非接触三维标测系统指导右心室流出道室早消融成功率高,判断室早起源新流程的敏感性、特异性与阳性预测值较先前报道的高,有良好的临床应用价值。     

体表心电图两步法快速判定流出道室性早搏的起源

目的:本文通过回顾既往消融成功的室性早搏(室早)病例,将其体表心电图与成功消融靶点部位比对,得出用两步法快速判定室早起源的心腔,以期在以后的室早射频消融治疗前能帮助确定消融策略.方法:66例成功消融的室早或室性心动过速患者,男30例,平均年龄(36.9±13.9)岁.其中经股静脉途径在右心室消融成功32例(右心室消融组),经股动脉途径在左心室?肖融成功34例(左心室消融组).结合文献,对明确了起源点的室早患者的四个心电图特征利用SPSS10.0软件进行分析.特征1:肢体导联Ⅰ、aVR、aVL和Ⅱ、Ⅲ、aVF导联及胸前导联V1的形态;特征2:V1导联r或R波时程;特征3:V1导联r或R波时程占总QRS时程的百分比(Dr/DQRS);特征4:R/S移行的胸前导联(即出现R/S≥1时的胸前导联).结果:R/S移行的胸前导联和Dr/DQRS两项体表心电图特征性指标对预测室早起源具有很强的指导性.其中R/S移行导联在V4～6导联判定起源点在右心室侧的敏感度只有37.5%,但是其判定室早起源点不在左心室侧(即在右心室侧)的特异度却达100%,相应地其判定起源点在右心室侧的阳性预测值为100%,阴性预测值为63%.进一步对余下的54例R/S移行在V1、V2、V3导联的病例采用Dr/DQRS进行分析,发现将这些患者以Dr/DQRS<0.5(n=19)和Dr/DQRst>0.5(n=35)分为两部分.其中以Dr/DQRS<0.5来判别消融靶点在右心窜侧的敏感度是90.0%,特异度为97.1%,阳性预测值为94.7%,阴性预测值为94.3%;而用Dr/DQRS≥0.5来判定消融靶点在左心室侧的敏感度为97.1%,特异度为90.0%,阳性预测值为94.3%,阴性预测值为94.7%.结论:本研究提示在室早射频消融手术前可依据R/S移行的胸前导联和Dr/DQRS两项体表心电图指标,只用两步即可对室早起源得到初步判定.     

儿童右心室流出道室性早搏的射频导管消融治疗

目的 观察射频导管消融治疗儿童频发右心室流出道室性早搏（室早）的疗效及安全性.方法 总结我院2003年7月至2009年4月经导管射频消融治疗的58例儿童室早,观察射频消融即刻和远期、不同部位、不同年龄、心脏扩大与否、放电时心律失常的反应等对成功率的影响,观察有无并发症及随访预后.结果 体表心电图判断室早与心内电生理检查结果完全符合 消融即刻总成功52例（89.7%） 消融放电时出现频发室早或窒性心动过速（窒速）者预示消融成功（P＜0.033）.而右心室流出道不同部位、心脏有无增大、患儿年龄对消融术成功率影响不大 远期成功率为86.2%.未发生任何远期并发症.结论 经导管射频导管消融可有效而安全地消除儿童正常心脏结构的右心室流出道单形性室早.     

右室流出道室性早搏的射频消融治疗

目的探讨射频消融治疗右室流出道室性早搏的方法和疗效。方法选择52例右室流出道室性早搏患者进行射频消融法治疗,男28例,女24例,年龄15~67岁,平均45.1岁;病史3~14年,平均6.8年均有明显症状,但无器质性心脏病的证据。多种抗心律药物治疗无效,心电图显示室性早搏均呈左束支阻滞图形,Ⅱ、Ⅲ、AVF导联为高大的R波。采用起搏标测。结果即刻成功率94%(49/52)。术前与术后1周24h动态心电图检查室性早搏为(11250~37460)次/24h和(0~1120)次/24h,两者间差异(P<0.01)。随访2~32个月,无复发。结论无器质性心脏病顽固性右室流出道室早的导管射频消融是一种安全可靠的方法。     

右心室流出道室性早搏射频消融治疗的有效性和安全性评价

目的评价应用Carto系统射频消融治疗右心室流出道起源性室性早搏（室早）有效性和安全性。方法选择2005年5月至2007年12月临床治疗的47例室早患者,其中男性21例,女性26例,平均年龄（34．5±19．2）岁,病程3～38个月。射频所用能量为40W,时间为120～240s,温度设定为60℃。分别在消融术前和术后1、3和12个月进行动态心电图检查。结果47例中成功45例,有效率为95．8％。2例1年后复发新的早搏,未发现任何并发症。结论应用Carto系统对右心室流出道起源性室早经射频消融治疗是有效和安全的。     

右室流出道室性早搏的导管消融治疗

目的　探讨右室流出道频发单形性室性早搏行射频导管消融治疗的可行性和有效性。方法　对 11例无器质性心脏病右室流出道频发单形性室性早搏患者进行射频导管消融 ,采用起搏标测 ,以起搏时与自发室早QRS波群图形完全相同的点为消融靶点。结果　消融即刻成功率 91% (10 / 11) ,所有患者无任何并发症 ,随访 1～ 30个月 ,无迟发并发症发生 ,无室早复发。结论　右室流出道频发单形性室性早搏予射频导管消融治疗有效、安全 ,具有可行性。     

射频消融治疗右室流出道室性早搏的研究

目的 探讨射频消融治疗右室流出道室性早搏(RVOT-VPC)的临床效果和安全性.方法 经常规体检、生化检查、X线胸片、心脏彩超、心电图等各种检查后入院.右室流出道室性早搏患者48例,采用起搏标测法,以心室起搏时12导联心电图与其临床室性早搏的图形完全一致作为消融靶点,以放电后:①早搏在10s内消失;②出现同形早搏先增多...     

射频导管消融治疗右心室流出道频发室性早搏的临床应用

室性早搏（室早）是临床上较常见的心律失常，发病人群相当广泛，包括健康者和各种心脏病患者。右心室流出道（RVOT）频发室早多是起源于RVOT的没有明显器质性心脏病及致心律失常因素基础上的室早，药物控制较差，采用射频导管消融治疗目前尚有争议，未广泛开展。本文总结我院22例症状明显、药物治疗无效的RVOT频发室早患者进行射频导管消融治疗，评价其治疗RVOT频发室早的安全性和疗效。[第一段]     

右室流出道室性期前收缩的心电图特征及射频消融治疗

目的:探讨右室流出道室性期前收缩(室性早搏,室早)的心电图特征和评价单导管法消融单形性右室流出道室性早搏的有效性、安全性和实用性。方法:对52例心脏结构正常的右室流出道单形性室早的心电图特征进行分析并行单导管射频消融。采用起搏标测法,以起搏时与自发室性早搏形态波形态完全相同点为消融靶点。结果:右室流出道的室性早搏体表12导联心电图特征,呈完全性左束支阻滞形态,Ⅰ导联呈rs、m、QS及R型,aVR、aVL均呈QS型,Ⅱ、Ⅲ、aVF、V5~6导联均呈单向R波型,胸前导联R波移行区常在V3、V4导联之后。成功消融结果显示26例室早起源右室流出道间隔部:其中前间隔7例、中间隔5例、后间隔14例,游离壁21例:其中前游离壁6例、后游离壁15例,希氏束附近1例,肺动脉瓣下1例。消融即刻成功率94%(49/52),未成功的3例。手术操作时间30~150 min,X线曝光时间5~29 min。术后随访2~48个月无复发。结论:起源于右室流出道的室性早搏有其独特的心电图表现,单导管射频消融可有效、安全地消融心脏结构正常的右室流出道单形性室性早搏。     

起源于右室流出道和三尖瓣环交界区的室性早搏的心电图特点和消融治疗

目的报道起源于右室流出道和三尖瓣环交界区(RTJ)的室性早搏(简称室早)的心电图特点和射频消融疗效。方法回顾性分析右室消融成功的室早的心电图和腔内电生理特点。根据室早起源部位分为右室流出道(RVOT)组,三尖瓣环(TV)组,RVOT与TV之间的区域(RTJ)组。另选5例无室早的阵发性室上性心动过速患者作为对照组。结果 RVOT组有78例,TV组有11例,RTJ组有12例。RTJ组的室早心电图在Ⅰ、Ⅱ、Ⅲ和aVF导联均为单相R波,aVL导联均为低平波形,rsr′、qs、qr、rs或r型,平均振幅为(0.3±0.1)mV,而RVOT组的室早aVL导联为深倒的S波,平均振幅为(-0.7±0.4)mV;TV组的室早aVL导联为直立的R波,平均振幅为(0.8±0.3mV)(P<0.05)。应用激动标测和起搏标测能成功定位RTJ室早并成功消融。5例对照组患者RTJ起搏在aVL导联产生低平QRS波形。结论 RTJ起源的室早并不少见,心电图aVL导联低平是区别于RVOT或TV起源室早的显著特点。射频消融治疗安全有效。     

顽固性右心室流出道室性早搏的定位及导管射频消融治疗

室性早搏 (室早 )是常见的心律失常 ,而起源于右心室流出道者所占比例较大 ,其中多数无症状 ,少部分患者有心悸、气短、乏力等症状 ,绝大多数患者未发现器质性心脏病 ,部分患者在交感神经兴奋时早搏明显增加 ,可成联律或成对出现 ,β受体阻滞剂对部分患者有效 ,但不能根治。导管射频消融技术发展至今已非常成熟 ,自 1998年以来 ,我们对 2 9例起源于右心室流出道的室早施行导管射频消融治疗 ,取得很好的疗效。资料和方法　　 2 9例患者 ,男性 16例、女性 13例 ,年龄 2 0～ 6 1(39 3± 10 9)岁。均为采用美托洛尔、普罗帕酮和 /或美西律治疗…     

Radiofrequency catheter ablation of upper septal idiopathic left ventricular tachycardia exhibiting left bundle branch block morphology

Idiopathic left ventricular (LV) tachycardia usually exhibits right bundle branch block morphology. There are only a few sporadic cases that exhibit left bundle branch block (LBBB) morphology. We report a patient whose QRS complex during ventricular tachycardia (VT) was relatively narrow (100 msec) and exhibited LBBB (precordial R wave transition between V3 and V4) and a normal frontal plane axis. This VT was ablated successfully by radiofrequency current applied to the LV upper septum, where the earliest endocardial activation was recorded.     

Electrocardiographic characteristics for predicting idiopathic right ventricular outflow tract premature ventricular complex-induced cardiomyopathy

Purpose

In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown.

Methods

A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) <?50%, n?=?25 and LVEF ≥?50%, n?=?105, respectively). The 12-lead PVC morphologies were assessed.

Results

Patients with RVOT PVC-CMP had a lower LVEF (42?±?5% vs. 60?±?7%, P?<?0.01) and higher PVC burden (24?±?14% vs. 15?±?11%, P?=?0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143?±?14 ms vs. 132?±?17 ms, P?<?0.01) and higher peak deflection index (PDI; 0.60?±?0.07 vs. 0.55?±?0.08, P?<?0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020–1.253, P?=?0.02) and PDI (OR 1.240, 95% CI 1.004–1.532, P?=?0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration >?139 ms and PDI >?0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP.

Conclusions

The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.

     

Catheter ablation of idiopathic exercise-induced right bundle branch block and left axis deviation ventricular tachycardia

Catheter ablation of ventricular tachycardia was performed in a patient without evidence of structural heart disease. ECG showed ventricular tachycardia and a right bundle branch block QRS configuration with left axis deviation induced by exercise and atrial pacing. At electrophysiology, presystolic activation was found in the low septal region of the left ventricle. Radiofrequency energy delivered to this site failed to prevent tachycardia. Three direct current shocks (total energy 400 J) delivered in this region rendered the tachycardia noninducible. There were no complications. During the follow-up period of six months the patient has remained free from arrhythmia on no medication. This report expands the use of catheter ablation to patients with idiopathic ventricular tachycardia ('verapamil responsive' ventricular tachycardia) originating in the left ventricle.     

单导管射频消融治疗右室流出道室性期前收缩

目的:观察单导管射频消融治疗右室流出道室性期前收缩（室性早搏,室早）的安全性和临床效果。方法: 经常规体检、生化检查、X线胸片、心脏彩超、长程心电图等各种检查后,入选65例患者,采用温控消融导管以起搏为主的方法进行标测,并对单导管射频消融的安全性和临床效果进行总结。结果: 消融即刻成功率97%(63/65),其中2例放弃消融术;随访15～40个月,有3例复发并再次手术,成功2例,总成功率为95%（62/65）,无复发。电生理检测和消融时间:(50±27) min;曝光时间:(8.1±3.8) min,所有患者术中及术后均未发生消融相关并发症。结论: 单导管射频消融治疗右室流出道室早安全有效,并能减少消融操作及X线暴露时间。     

Evaluation of left ventricular diastolic functions in patients with frequent premature ventricular contractions from right ventricular outflow tract

This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 ± 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 ± 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts.