特发性室性心动过速与继发性室性心动过速临床特点分析

目的探讨特发性室性心动过速（特发性室速）与继发性室性心动过速（继发性室速）的临床特点。方法收集23例特发性室性心动过速、21例病因明确的继发性室性心动过速病人的资料,分别从临床表现、心电图特点和治疗进行对比分析。结果两组比较：特发性室速病人年龄较轻,病程较长,出现晕厥及血压下降者较少;室速发作时,左室特发性室速心电图主要表现为右束支传导阻滞（RBBB）＋电轴左偏,右室特发性室速主要表现为左束支传导阻滞（LBBB）＋电轴右偏。结论掌握特发性室速的临床特点,有利于此类病人的诊断、治疗和预后判断。     

分支性室性心动过速的临床研究

本文对 2 1例分支性室速的临床特点、心电图表现 ,及治疗反应进行研究。结果表明 ,此型室性心动过速病人均为年轻病例 ,无临床心脏病器质性证据 ,心动过速反复发作。发作时 ,心电图呈右束支阻滞伴电轴左偏或右偏。心动过速终止后 ,下壁和前壁导联呈T波倒置 ,故极易误诊为心肌缺血。此型室速对异博定有特效 ,预后良好。     

分支性室性心动过速的临床研究

目的 分析研究分支性室性心动过速(FVT)的临床特点、心电图表现和诊治方法.方法 选取我院2008年7月～2010年2月期间收治的23例分支性室性心动过速患者的临床资料进行回顾性分析.结果 23例分支性室性心动过速患者的心动过速反复发作.发作时,心电图呈右束支传导阻滞图形,且伴有电轴偏移,电轴右偏9例,电轴左偏14例.当心动过速终止后,下壁和前壁导联呈ST段压低,T波倒置图形,易误诊为心肌缺血和心内膜下心肌梗死.结论 分支性室性心动过速(FVT)起病急骤,需及时准确诊断和治疗,一般可以治愈,且预后良好.     

特殊类型分支型室速1例报道

分支型室性心动过速又称为维拉帕米敏感性室速,系特发性室性心动过速一种比较常见的类型[1].一般情况下,分支型室性心动过速患者的心动过速呈持续性发作,其心电图(ECG)表现为不完全性或完全性的右束支传导阻滞(RBBB)图形,QRS波常不增宽,伴电轴左偏或右偏[2]. 而90%~95%的患者ECG均表现为RBBB+心电轴左偏, 提示患者的室速起源点位于左后分支分布区即左下后间隔[3].     

导管射频消融治疗36例右室室性心律失常临床分析

目的 探讨经导管射频消融(RFCA)治疗右室室性心律失常疗效.方法 36例右室室性性心律失常中男性16例,女性20例,年龄(43.21±13.31)岁.5例为致心律失常性右室心肌病(ARVC),31例为特发性右室流出道室性心律失常.31例特发性右室流出道室性心律失常采用传统的起搏与激动标测.5例ARVC在非接触标测系统EnSite3000指导下进行消融治疗.结果 35例消融成功,1例失败,成功率97%.1例复发.右室流出道(RVOT)起源的(VT)和室性早搏(PVC)具有典型的心电图特征,表现为典型的左束支传导阻滞型伴电轴右偏.RVOT的起源点不同,其12导联心电图特征不同,I、Ⅱ、Ⅲ和avF导联呈RR'型.v1～v3具有深S波是游离壁起源的特征.ARVC表现为典型的左柬支传导阻滞型伴电轴右偏,窦性心律时v1～v3T波浅倒置,心脏核磁或心脏超声心动图见有室心肌运动减弱.1例ARVC病例在消融过程中出现室颤,经电除颤后继续消融成功.结论 RFCA是一种安全、有效的治疗方法.EnSite3000非接触标测系统定位快速准确,适用于ARVC等血流动力学不稳定的心律失常和多起源的复杂室性心律失常的标测.     

良性分支型心动过速：文献复习及病例报告

有些室性心动过速,QRS时限轻度增宽(≤0.12s)常表现为右束支传导阻滞并电轴左偏、右偏或左束支传导阻滞图形。因此类室速异位节律点多位于左束支的某     

特发性室性心动过速的体表心电图定位

特发性室性心动过速 (简称室速 )的频率一般在 130— 2 30次 /分 ,ＱＲＳ波宽大畸形 ,伴或不伴有室房分离 ,根据起源部位主要分为左室特发性室速和右室特发性室速。1　特发性左室室速 (ＩＬＶＴ)大多数特发性左室室速呈右束支阻滞形态 ,电轴左偏 .根据胸前导联ＱＲＳ形态 ,肢导联ＱＲＳ电轴及胸 ,肢导联的特征形态改变 ,基本上可准确定位室速起源点。1.1　起源左室间隔面室速ＱＲＳ形态呈右束支阻滞形态 ,ＱＲＳ波宽度较窄 (0 .11— 0 .14 ) ,肢导联ＱＲＳ电轴左偏或极度右偏 ,80 %以上ＩＬＶＴ起源于这一部位。在ＲＡＯ30投照体位下将心尖…     

分支性室性心动过速的心电图和临床诊断(附7例报告)

本文报道7例分支性室性心动过速(室速)患者。年龄最大33岁,最小20岁,平均21.9岁。临床无明显器质性心脏病。心电图表现为右束支阻滞伴电轴左偏或右偏和左束支阻滞图型。心室率最高200次/bin.最低107次/min,平均156次/min。用异搏定和心律平药物可中止室速反复发作.恢复窦性心律后,心电图见Ⅱ、Ⅲ.avF、V4～V6导联 T 波例置或低平,不需特殊治疗,可恢复正常。     

分支性室性心动运速八例心电图分析

对８例分支性室性心动地速的患者心电图进行分析。根据发作时心电图特点分为右束支阻滞＋电轴左偏７例；右束支阻滞＋电轴右偏１例。持续型发作７例；非持续型发作１例。经药物治疗均可使发作终止，临床上对８例患者进行体格检查，超声心图检查及Ｘ线胸站拍片均未发生任何哭喊 质笥心脏病的证据，随访１年，预后良好。     

小儿快速型心律失常46例诊治分析

目的:提高小儿快速型心律失常的诊治水平。方法:通过对我院近8年来急诊入院的46例快速型心律失常患儿进行病案回顾性总结,对临床资料、心电图特点及诊治经过进行临床分析。结果:(1)46例患儿中,40例为室上性心动过速(SVT),6例为特发性室性心动过速(IVT)。(2)40例SVT中,26例为阵发性室上性心动过速(PS-VT),心律平对PSVT的总有效率达88.24%。(3)6例IVT心电图均呈窄QRS波伴室房分离。4例IVT起源于左心室,心电图呈右束支阻滞 电轴左偏,对异搏定敏感;2例起源于右心室,心电图呈左束支阻滞 电轴右偏,心律平、利多卡因有效。结论:(1)小儿快速型心律失常起病急,预后与原发性心脏疾患有很大关系,经及时救治绝大多数能转律,预后均较好。(2)小儿快速型心律失常最常见为PSVT,心律平可作为急诊治疗PSVT的首选药物。(3)小儿IVT多呈窄QRS波,室房分离是诊断IVT的有力依据。起源于左室的IVT对异搏定敏感。     

不同类型特发性室性心动过速的临床特点及射频消融治疗

目的 回顾性分析不同类型特发性室性心动过速(IVT)患者的临床特点及射频消融治疗情况.方法 165例IVT病人,根据心电图特征,采用心脏内"起源处"分类方法,其中右室流出道IVT 86例,平均年龄[36±12(18～56)]岁,男26例,女60例.左室间隔IVT 75例,平均年龄[26±15(16～45)]岁,男54例,女21例.左冠窦IVT 4例,年龄分别为(22、40、45、70)岁,男2例,女2例.所有病人均接受导管射频消融手术治疗.结果 右室流出道IVT男:女=1:2.3;左室间隔IVT男:女=2.6:1.左室间隔IVT发病年龄较右室流出道IVT更为年青(P＜0.01).IVT发作时心电图形态:右室流出道IVT均为左束支阻滞图形,30例主要表现为频发短阵IVT;左室间隔IVT均为右束支阻滞图形,多表现为持续性IVT,仅4例表现为频发短阵IVT;左冠窦IVT均为不典型束支阻滞图形,额面电轴向下,3例于V3过渡为"R",1例于V2过渡为"R",表现为频发室性早搏和短阵IVT.右室流出道IVT均为起搏标测消融,治疗成功率100%,4例复发,再次消融成功;左室间隔IVT以激动标测时最早的P电位为消融靶点,治疗成功率95%,5例复发,3例再次消融成功,2例拒绝再次手术;左冠窦IVT均为起搏标测消融成功.结论 IVT主要见于青壮年.右室流出道IVT多见于女性,而左室间隔IVT多见于男性.射频消融治疗是根治IVT的有效方法.左室间隔IVT常为持续性,主要在激动标测时消融;而右室流出道IVT和左冠窦IVT多表现为频发短阵IVT和室性早搏,多采用起搏标测消融.左冠窦IVT相对较为少见,当IVT呈不典型束支阻滞图形,特别是胸前导联R波在V2、V3迅速过渡时,应考虑左冠窦IVT的可能.     

射频消融治疗特发性室性心动过速9例临床报告

目的观察射频消融技术治疗特发性室性心动过速 (IVT)的临床效果。方法根据发作IVT时的体表 12导联心电图定位起源部位 ,行心内电生理检查 ,寻找稳定诱发IVT的条件 ,采用激动标测或 (和 )起搏标测相结合的方法标测靶点 ,对起源左心室间隔部的IVT寻找Purkinie电位 (p电位 ) ,标测靶点后放电消融。结果 11例呈RBBB图形伴电轴左偏或重度右偏 ,靶点在左心室间隔面中、下部 ,10例找到p电位。 7例为LBBB图形伴电轴不偏或右偏 ,靶点在右心室流出道 ;1例为LBBB图形伴电轴左偏 ,靶点在右心室流人道。l例IVT同时起源右室流出道的间隔部和游离壁 ,l例左心室特发性室性心动过速 (ILVT)合并房室结折返性心动过速的患者先消融房室结双径路 ,再行ILVT的消融。 1例右心室特发性室性心动过速 (IRVT)消融虽未立即成功 ,因延迟作用 3周后心动过速消失。消融成功患者的临床症状消失 ,未出现手术相关的并发症 ,随访期内所有病例存活。结论射频消融治疗IVT临床疗效肯定、成功率高、安全 ,应作为首选的根治方法。     

Radiofrequency catheter ablation at the left coronary cusp in treatment of repetitive monomorphic tachycardia of the left ventricular outflow tract

Background The aim of this study was to clarify the electrocardiographic characteristics of repetitive monomorphic ventricular tachycardia (RMVT) originating from the left ventricular outflow tract, and to describe the results of treatment with radiofrequency catheter ablation (RFCA).Methods Routine 12-lead surface electrocardiography and electrophysiological studies were performed on 11 RMVT patients with no organic heart disease, who were subsequently treated with RFCA directed at targets identified by pace mapping.Results The surface electrocardiogram QRS characteristics of RMVT included an atypical left bundle branch block and right axis deviation, with a low amplitude “rs” or “rS” pattern in lead Ⅰ, an “rS” or “RS” pattern in V1, and a precordial R wave transition zone in V2 or V3. In 1 patient, a small S wave was observed in V5. Using pace mapping techniques, we selected the left coronary cusp as the ablation target. RMVT was eliminated in all 11 patients immediately after radiofrequency energy delivered. During a follow-up of 13±7 months, RMVT recurred in only 1 patient. Conclusion RMVT originating from the left ventricular outflow tract has specific electrocardiographic characteristics, and can be successfully and safely cured using RFCA directed at the left coronary cusp.     

缺血性心肌病伴完全性左束支传导阻滞患者心室运动同步性的超声研究

目的：应用超声心动图技术比较孤立性左束支传导阻滞患者与缺血性心肌病（ICM）伴完全性左束支传导阻滞（CLBBB）患者左心室内、左右心室间收缩运动同步性的差异。方法：选择30例孤立性左束支传导阻滞患者纳入对照组。选择32例ICM伴CLBBB心衰患者纳入病例组。应用定量组织速度成像（QTVI）技术测定左室前后间隔、侧壁、前壁及下壁、后壁基底段及中间段共约12节段沿左室长轴运动的收缩期达峰值时间的标准差（Ts-SD）,M超测定胸骨旁长轴方向室间隔与左室后壁的时间延迟（SPWMD）,脉冲多普勒测定左右心室射血前时间差（IVMD）。结果：与对照组相比,病例组Ts-SD、SPWMD、IVMD明显增大（P〈0.001）。线性相关分析发现,左室内及左右心室间运动不同步与左室大小、QRS波宽度及N末端脑钠肽前体（NT-pro BNP）浓度呈正相关。结论：ICM伴CLBBB患者左心室内及左右心室间运动存在明显的不同步性。超声技术在评价心室运动不同步方面具有一定价值。     

Insights into the mechanism of idiopathic left ventricular tachycardia: a case report and literature review

Left ventricular posterior fascicular tachycardia (LVPFT) is an idiopathic form of VT characterized by right bundle branch block morphology and left axis deviation. The mechanism of LPFVT is thought to be localized reentry close to the posterior fascicle. We present the case of a 24-year-old medical student who was admitted to the emergency department complaining of palpitations. The ECG showed an aspect suggestive of LVPFT. Vagal maneuvers, adenosine and i.v. Metoprolol were ineffective in terminating the arrhythmia. Conversion to sinus rhythm was obtained 10 h later, with i.v Amiodarone. The ECG in sinus rhythm showed left posterior fascicular block. Because antiarrhythmic drugs were not desired by the patient, VT ablation was proposed. The electrophysiological study identified the mechanism of arrhythmia to be reentry using the slowly conducting verapamil-sensitive fibers as the antegrade limb and the posterior fascicle as the retrograde limb. Radiofrequency applications near the posterior fascicle, in the lower half of the interventricular septum, at the junction of the two proximal thirds with the distal third interrupted the tachycardia and made it non-inducible at programmed stimulation. The case is unusual as the patient had a left posterior fascicular block during sinus rhythm before ablation. This demonstrates that the reentry circuit of VT does not need antegrade conduction through the posterior fascicle for perpetuation.     

分支性搏动与室性心动过速的诊断与治疗（附2例报告）

本文报告２例无明显器质性心脏病、心电图示ＱＲＳ时限＜０．１２秒、呈不完全性束支传导阻滞伴电轴偏移的分支性室性心动过速患者。室速经静注异搏定和心律平能中止发作，而对利多卡因静注反应差。并就此类心律失常的诊断与治疗作了简要讨论。     

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

心电学的新理念——碎裂QRS波

碎裂QRS波是指两个相关导联QRS波群(<120 ms)呈RSR′型(≥1个R′波、或R波、S波存在切迹),但并无典型束支传导阻滞的心电图图型。碎裂QRS波常见于急性心肌梗死,但其检出率尚待进一步研究;而在陈旧性心肌梗死的诊断中它优于病理性Q波;它是心脏事件的独立预测因子,可作为高危患者预警的心电图新指标;它是非透壁性心肌瘢痕的标志;左侧胸导联出现碎裂QRS波是室壁瘤的标志。     

Left posterior fascicular block: a new endpoint of ablation for verapamil-sensitive idiopathic ventricular tachycardia

Verapamil-sensitive idiopathic left ventricular tachycardia with a right bundle-branch block and left-axis deviation morphology, which occurs in young adults without structural heart disease is an uncommon but well described clinical arrhythmia. This ventricular tachycardia (VT) is known to be due to re-entry mechanism and the re-entrant circuit is localized in the left ventricular septum.1-10 However, the relationship between Purkinje potential and the reentrant circuit is still controversia…