特发性室性心动过速与宽QRS室上性心动过速的诊断和射频消融治疗

目的　报道特发性室性心动过速 (IVT)和宽QRS室上性心动过速 (SVT)的鉴别诊断和射频消融术 (RFCA)结果。方法　 85例患者 ,记录心动过速发作时 12导联心电图和或食道心电图 ,常规方法进行电生理检查和射频消融。诱发的宽QRS心动过速 (WQRST)若室 房 1∶1传导 ,静脉注射三磷酸腺苷 2 0～30mg ,观察有无室房分离 ,则明确室性或室上性心动过速的诊断 ,并确定心动过速的靶点位置进行消融。 结果　 85例患者 ,其中 4 5例心电图为右束支传导阻滞 电轴左偏 ,食管心电图 5例室房 1∶1传导 ,心内电生理诊断为左室特发性室速 (ILVT) ,4 4例左室中后间隔消融成功。 6例心电图表现为左束支传导阻滞 II、III、avF导联高大R波 ,心内电生理诊断右室流出道室速 3例 ,左室流出道室速 1例 ,消融成功 ;1例房性心动过速Maiham氏纤维前传 ,于右侧游离壁消融成功 ;1例疑为特发性心外膜左室流出道室速。 34心电图诊断为SVT并束支阻滞病例 33例电生理确诊为SVT ,1例为ILVT ,消融成功。结论　RFCA术前对WQRST图形 ,必要时结合食道心电图描记进行仔细...     

左前游离壁及左后间隔双旁道的诊断与射频消融治疗体会

目的　报道左前游离壁及左后间隔双旁道射频消融治疗的体会。方法　 8例室上性心动过速患者 ,发作时QRS波呈单一图形者 2例 ;图形基本一致 ,频率不同者 3例 ;出现两种不同图形者 3例 ,其中频率一致图形不同者 2例 ,频率和图形均不一致者 1例。经心内电生理检查及射频消融治疗。结果　① 8例患者均消融成功 ,无并发症发生 ,随访 15～ 36个月均无复发 ;②术中证实均存在左前游离壁及左后间隔双旁道 ,两旁道相距 >2cm。结论　对室上速发作时频率和图形不一致患者要考虑多旁道存在。     

射频消融治疗左室特发性室性心动过速1例

患者男性,41岁,因发作性室性心动过速5年入院,发作频率多达10次/月,每次持续时间长短不一,室速频率150～180次/分之间,伴有胸闷、心悸、乏力、无晕厥及意识丧失,用维拉柏米可终止室速发作,给予普罗帕酮、乙胺碘呋酮治疗无效。室性心动过速(VT)发作时心电图(ECG)为右束支阻滞型(RBBB),伴电轴左偏,同时有左前分支阻滞。体检、超声波、胸片检查未发现器质性心脏病证据,诊断为左室特发性心动过速(ILVT)。术前停用抗心律失常药物。电生理检查及射频消融治疗:连接12导联     

探讨激动标测联合窦律下射频消融术治疗左后分支型室性心动过速的疗效

 目的 探讨心动过速下激动标测联合窦性心律下射频消融治疗左后分支型室性心动过速(left ventricular posterior fascicular tachycardia, LVPFT)的临床疗效。方法 2016-10至2018-09在武警特色医学中心就诊的LVPFT患者6例,男5例,女1例,年龄18~33岁,平均(24.4±5.8)岁,无器质性心脏病证据。采用Carto-3系统,窦性心律下构建室间隔左后分支区域。诱发心动过速后在左后分支区域激动标测最早V波。终止室速,窦性心律下于最早V波附近标测并消融碎裂浦肯野电位(Purkinje potential,PP)至消失。在该消融点近基底段约1 cm左右处,再次标测正常PP电位并消融至消失,或体表ECG下壁导联呈qR型。结果 6例手术全部成功,手术时长(117.5±15.1)min,X线剂量(77.5±32.9)mGy,平均消融(6.5±1.5)次,消融时间(4.7±1.5)min,无严重并发症。术后随访6~30个月,平均(16.5±8.4)个月,无心动过速复发。结论 激动标测联合窦性心律下射频消融治疗LVPFT的方法,初步研究显示治疗靶点指向性强,安全有效,具有临床实用性。     

射频消融起源于左下肺静脉的自律性房性心动过速一例

报道 1例少见的起源于左下肺静脉 (PV)的自律性房速的电生理特征及射频消融结果。患者女 ,31岁。 5年前出现发作性心悸 ,每次持续 10～30min ,发作时心电图提示室上速 (PR >RP) ,心室率 2 0 0次/min左右 ,可自行缓解。近 3个月发作频繁 ,数天发作 1次或 1天发作数次 ,每次持续数分钟至数小时 ,时伴晕厥前症状 ,口服普罗帕酮和维拉帕米等药物无效。无高血压等病史 ,入院后体检、胸片、ECG、心脏超声等检查无异常。 2 4h动态ECG检查均发现有频发房早及反复发作的阵发性室上速。常规放置希氏束、右心室、右心房、冠状静脉窦导管行心电生理…     

特发性左心室室性心动过速消融中心动过速发生电轴改变的电生理机制

目的　探讨特发性左心室室性心动过速 (VT)射频消融放电过程中VT由电轴左偏转变为电轴右偏的电生理机制。方法　 2 2例特发性左心室VT患者 ,VT发作时心电图均表现为右束支阻滞伴电轴左偏。电生理检查确定此 2 2例患者为起源于左心室左后分支区域VT。经股动脉送入消融导管至左心室 ,按寻找VT时最早Purkinje纤维电位 (PP)或舒张期电位 (DP)部位的方法进行射频消融。采用温控法放电(5 5℃～ 6 0℃ ,能量最高 5 0W ) ,如放电 10～ 30s无效 ,则重新标测消融靶点。结果　 2 2例患者的VT均消融成功 ,其中 2例在放电过程中出现VT由电轴左偏改变为电轴右偏 ,但VT周长无明显变化。在发生此改变的放电处PP均提前VT时体表心电图QRS波 30ms。窦律时体表心电图也均表现为电轴右偏。VT由电轴左偏改变为电轴右偏后局部PP距希氏束电位时间不变 ,但PP距体表心电图QRS波时间由 30ms分别延长为 5 0ms和 4 0ms。在发生VT和窦律下体表心电图电轴改变前分别在VT时PP较为提前的部位消融 4次和 3次。最后VT均在发生电轴改变消融处的上方 ,局部PP或DP在VT时分别提前体表心...     

射频治疗无休止性室性心动过速1例

1 病例报告 　　病人男,23岁,反复特发性胸闷、心悸1年,再发5 d 入院.每次发作持续数小时至数天.体检、X线胸片及超声心动图检查无异常,心电图示电轴左偏,呈右束支加左前分支阻滞型室性心动过速;QRS 时限0.12s,心室率136/min.动态心电图检查:室性心动过速24 h无休止发作.诊断:无休止性特发性室性心动过速. 　　……     

射频消融证实A型预激合并右束支传导阻滞1例

患者男性,67岁。有反复发作陈发性心动过速史5年余,临床诊断:A型预激综合征。消融前心电图(图IA)示:窦性心律,P-R间期<0.12s,QRS时限0.16s,V1~V6导联delta波与QRS波主波方向一致,V1导联R波顶部有切迹,仔细观察可见I、aVL、V3~V6导联QRS波终末部粗钝,P-J间期0.27s。因室上速反复发作(图1C),频率在158次/min,于2005年10月17日成功进行左侧显性旁路(左前侧)射频消融术,术后呈完全性右束支传导阻滞图形(图1B)。心电图诊断:l.窦性心律;2.A型预激综合征;3.室上性心动过速;4.完全性右束支传导阻滞。路,从而引起心室肌提前激动,改变了心…     

导管射频消融治疗突发性室性心动过速3例

导管射频消融术 (ＲＦＣＡ)治疗室性心动过速 ,特别是实发性室性心动过速 (ＶＴ)已取得较好的效果。 19992 0 0 0年我们采用ＲＦＣＡ治愈左室实发性室性心动过速 (ＩＬＶＴ) 3例 ,报告如下。1　临床资料1 1　一般情况　本组男 2例 ,女 1例 ;年龄 142 1岁。经心脏物理检查、Ｘ线片、静息及运动心电图、超声心动图等检查 ,心脏结构及功能正常。例 1病程 6个月 ,152 0ｄ发作 1次 ,频率 178/ｍｉｎ ,均需药物 (普罗帕酮、维拉帕米 )终止 ,持续 112ｈ。例 2病程 5年 ,每 12个月发作 1次 ,持续 30ｍｉｎ4 8ｈ ,频率2 10 /ｍｉｎ ,静脉注射维拉帕米…     

非器质性心脏病多形性室速17例

目的　报道 17例多形性室速、室颤而无明显的器质性心脏病患者的临床特点及诊断、治疗。临床资料　 17例患者 ,男 11例 ,女 6例 ,年龄 12～ 6 0岁 (平均 37± 12岁 )。病史 1周～ 3年 ,均为反复发作心慌伴晕厥。体格检查除有心律失常外无其它阳性体征。胸片 ,超声心动图示心脏结构、功能正常 ;3例年岁较高者行冠脉造影正常 ;心肌酶谱、电解质 ,甲状腺功能无异常。 17例患者 ,4例静息心电图正常 ,其中 1例住院期间行动态心电图检查时于睡眠中猝死 ,2例室性心动过速发作时任何药物无效 ,仅电复律能终止 ,2年后也于睡眠中猝死于家中 ,另 1例失访 ,考虑特发性室颤。 4例有完全性或不完全性右束支阻滞 ,虽然高度怀疑Brugada综合征或致心律失常性右室发育不良 ,但动态及静息心电图均未发现有ST抬高 ,多普勒超声心动图也未发现右室有明显异常。其中 1例间断服用倍他乐克和普罗帕酮 ,随访 10年间发作 2次室颤 ,均电复律成功。 5例有明显的QT延长者 ,2例是兄妹 ,考虑先天性QT间期延长综合征 (LQTS) ,1例并窦缓行VVI起搏器 +β受体阻滞剂治疗 ,1例行ICD ,其余 3例均服用 β受体阻滞剂 ,随访期间未发生晕厥。 3例为极短联间期尖端扭转型室速 (Tdp)、室颤 ,1例间断服用维拉帕米 ,2年期间发作 1次 ;1例服胺碘酮随访1     

Ventricular tachycardia in a patient with double valve replacement and bilateral coronary artery fistulas

A young patient presented with hemodynamic instability due to wide QRS tachycardia occurring about 10 years after double valve replacement. Bilateral coronary artery fistulas draining into the pulmonary artery were documented by invasive coronary angiography as well as by computed tomography imaging. A calcified scar of the posterolateral left ventricle was considered to be the origin of the clinical ventricular tachycardia. Although additional pathological findings are rare in young patients with valvular heart disease, diagnostic imaging of the heart is mandatory prior to cardiac surgery.     

完全性左束支传导阻滞合并左室肥厚的心电图分析

目的：探讨完全性左束支传导阻滞合并左心室肥厚的心电图改变。方法：对27例经超声心动图（UCG）和/或X线心脏检查,对ECG的RV5（V6）＋SV1（V2）、Rx＋Sz、空间QRS向量、QRS时间、额面QRS电轴等测量分析。结果：证实有LVH者12例,分为甲组;无LVH者12例,乙组;3例双侧心室肥厚未予以分组。统计结果两组额面QRS电轴及QRS电压无显著性差异（P〉0.05）,QRS时间有极显著性差异（P〈0.001）。结论：在CLBBB时,诊断LVH以QRS时间≥150 ms为标准,较额面QRS电轴及QRS电压指标敏感可靠。     

实时三维超声心动图评价不同QRS间期心衰患者左室收缩同步性的研究

目的探讨实时三维超声心动图在评价不同QRS波时限的心力衰竭患者左室收缩功能及其同步性上的可行性和临床价值。方法27例正常对照组（A组）及35例病例组（B组）均进行二维和三维超声心动图检查;依据QRS宽度将B组分为B1组、B2组。获取各组的左室射血分数（LVEF）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）;应用Qlab软件描绘左室容量一时间曲线,计算左室16节段、12节段收缩期容积达峰时间的标准差（Tmsv—SD）、最大差异（Tmsv—Dif）及其标准化值（Tmsv—SD％、Tmsv—Di物）;常规体表心电图记录QRS时限。结果①Bl、B2两组LVEF、LVEDV、LVESV及收缩同步性参数与A组比较,差异均有统计学意义（P〈0．05）。②A组左室收缩均呈同步性,B1组中33％的患者收缩不同步,B2组中78％的患者收缩不同步。结论①无论心力衰竭患者的QRS波时限增宽与否,均有一定比例患者存在心脏运动不同步现象。②RT-3DE能够准确评价不同宽度QRS时限心衰患者的心肌收缩同步性。     

急性雪山一支蒿中毒心电图的特点(附16例分析)

目的　探讨急性西藏雪山一支蒿中毒的心电图特点 ,为临床诊治提供参考依据。方法　于病人入院后 0 .5 h～ 2 d内常规记录治疗前后 1 2导心电图。结果　窦性心动过缓伴不齐 6例占 3 7.5 % ,交界性心律 2例占 1 2 .5 % ,室性 (单源或多源频发性 )过早搏动 8例占 5 0 % ,室上性 2例占 1 2 .5 % ,室性心动过速 5例占 3 1 .2 5 % ,心室颤动 2例占 1 2 .5 % ,房室传导阻滞或束支传导阻滞 8例占 5 0 %。同一病人可同时表现出 2种以上或多种形式的心电图。结论　雪山一支蒿毒素直接和间接作用于心脏 ,可引起各种心律失常 ,且严重程度与中毒程度呈正相关     

Differentiation of RVOT-VT and ARVC in an elite athlete

BACKGROUND: Differentiation of right ventricular outflow tract-ventricular tachycardia (RVOT-VT) and arrhythmogenic right ventricular cardiomyopathy (ARVC) can be problematic in athletes. The high incidence of sudden death as the first clinical manifestation in ARVC highlights the importance of correct diagnosis and treatment. We report on the case of RVOT-VT in an elite female sprinter, and we review the literature on ventricular tachycardia (VT) in the absence of structural heart disease and ARVC. DISCUSSION: Of patients who present with VT, 10% have no obvious structural disease. In the case of idiopathic VT from the RVOT and LVOT, the arrhythmia is monomorphic and generally not familial. In both disorders, the resting ECG has no identifiable abnormalities, and the echocardiogram and coronary angiography are usually normal. ARVC is a heart muscle disorder characterized by structural and functional abnormalities of the right ventricle due to a fibro-fatty replacement of the myocardium. The natural history of ARVC is considered to include four distinct phases. The early concealed phase of ARVC demonstrates ECG abnormalities concomitant to right and left ventricular dyskinesias. Differential diagnosis during this phase is problematic due to the presence of left bundle branch block morphology VT together with ECG anomalies commonly observed in athletes in RVOT-VT. Furthermore, long-standing VT in RVOT-VT may result in ventricular wall motion abnormalities mimicking ARVC. Radiofrequency ablation may be a valuable tool in the differential diagnosis, because this technique is highly effective in the treatment of RVOT-VT and of limited value in ARVC. Continued follow-up evaluation is an important for the confirmation of disease status after the diagnosis of idiopathic RVOT-VT.     

Relationship between the occurrence of late potential and the location and size of myocardial infarction evaluated by thallium-201 SPECT

High-frequency, low amplitude signals, late potentials (LPs), in the terminal portion of the body surface QRS of the signal-averaged ECG were frequently observed in ventricular tachycardia (VT) following myocardial infarction (MI). In this study, we evaluated the correlation between the occurrence of LPs and the size and location of MI estimated by Thallium-201 myocardial SPECT in 30 MI patients. The positive LPs were identified by the value of %RMS 40, the percent ratio of the root mean square voltage in the last 40 msec of the QRS complex to that of the total filtered QRS from the signal averaged ECG using bipolar X, Y, Z leads. The spatial distributions of LPs were evaluated by the LP30 area maps obtained by the body surface mapping using forty-five unipolar electrodes. Sixty projections were obtained over 180 degree by rotating gamma camera after 5 minutes intravenous injection of 74 MBq of Thallium-201. After low-pass filtering, images were reconstructed into short-axis, horizontal long-axis and vertical long-axis tomograms. The maximum count circumferential profiles for each short-axis cuts were generated from the apical to basal cut and they were expressed into two-dimensional polar functional maps (apex to the center), Bull's-eye map, to represent myocardial Tl distribution. Normal limits of myocardial Tl distribution were established as the mean minus 2 standard deviation from those of normal subjects. The MI size was estimated as defect volume ratio (DVR), the percent ratio of abnormal region to that of total volume of left ventricle. Significant differences in DVR were observed among MI with LPs and without LPs.(ABSTRACT TRUNCATED AT 250 WORDS)     

左心室肥厚并急性心肌梗死室性电风暴心电图对预后的影响

目的 探讨沿海居民高血压性左室肥厚(left ventricular hypertrophy,LNH)并急性心肌梗死(acute myocardial infarction,AMI)后心电图特征性改变,评估室性电风暴与临床预后危险分层.方法 选择急诊住院有高皿压性LVH并AMI室性电风暴(室速或室颤)317例(Ⅱ组),另选无高血压性LVH室性电风暴AMI 109例(Ⅰ组)进行心电图检查和持续心电监护,分析心电图特征与临床高危特点.结果 室性电风暴组以高血压LVH并AMI患者心电图指标心房终末电势异常、∑ST段抬高振幅、ST段抬高导联数、QTc间期延长、对应导联ST段振幅下移等特征,梗死部位以前壁或复合前壁,并以左前降支合并回旋支或/和右冠脉完全闭塞多支病变为主,与Ⅰ组比较差异有统计学意义(P<0.05或P<0.01),临床并发泵衰竭、AMI扩展、住院病死率、室性电风暴AMI发病后6 h内发生率明显增多(P<0.01).结论 高血压性LVH并AMI室性电风暴患者,心电图多项指标异常对临床预后有预测作用.     

A study of ventricular contraction sequence in complete right bundle branch block by phase analysis

Twenty-four patients with complete right bundle branch block (CRBBB) combined with and without left axis deviation (LAD) on ECG, were compared with 17 normal subjects to evaluate the right ventricular contraction sequence and pattern in detail. Blood pool scintigrams were obtained in the left anterior oblique projection, and these images were analyzed by first component Fourier harmonics. In the normal subjects, the phase value distribution representing the pattern of ventricular contraction was almost homogeneous in both the right and left ventricles (RV & LV). In the CRBBB patients without LAD, the phase images showed apparent phase delay in the right ventricle. In the CRBBB patients with LAD, the phase images showed many different contraction patterns varying from normal to RV phase delay, owing to the effects of the hemi-block. Quantitative analysis of the absolute values, showed that the mean (RV-LV) value was 6.6 +/- 8.4 msec in the normal subjects. In the CRBBB patients without LAD, the duration of the QRS complex correlated with the mean (RV-LV) value, whereas no difference was observed between the duration of the QRS complex and the standard deviation of the right ventricle. Using phase analysis the degree of the RBBB can be determined from the phase images, and can be quantitatively analyzed as in electrical studies.     

12导同步心电图实时处理

目的 识别和分析12导同步心电的异常心律及P、QRS、T波起点和终点。方法 一种建立在正交化处理基础上实时算法,该算法用空间速率样本识别各个心动;用平均空间速率和平均心电图计算平均参数;用瞬时心动周期,瞬时平均心动周期和瞬时QRS宽度进行心律异常分析。结果 本算法能准确的识别12导同步心电的P、QRS、T波起点和终点,并能较好的识别早搏,漏搏、RonT、二联律,三联律等异常心律,结论 12导同步心电图的正交化和形成空间速率是本方法的核心,它为分析其它参数奠定了良好的基础。