左室特发性室速误诊为室上性心动过速5例分析

目的 :分析起源于左室后间隔特发性室速的临床及电生理特点 ,探讨其误诊为室上性心动过速的原因及两者的鉴别要点。方法 :回顾分析 1999～ 2 0 0 2年住院的左室特发性室速 5例 ,平均年龄 2 7岁 ,男 4例 ,女 1例 ,心动过速均有突发突止 ,不伴血流动力学障碍 ,且对异搏定敏感的特点 ,均在外院误诊为室上性心动过速伴差异性传导 ,射频消融未成功。结果 :本组 5例电生理检查心室程控刺激诱发心动过速 ,伴有室房分离 ,ECG显示右束支传导阻滞 ,有时合并左前分支阻滞 ,电轴不偏或左偏 ,在左后间隔最提前的 P电位处消融后心动过速不能被诱发。结论 :起源于左后间隔的特发性室速临床表现与室上速相似 ,但 ECG V1 和 V6 导联的形态有助于和室上性心动过速伴差异性传导相鉴别

Analysis of 5 Cases of Idiopathic Ventricular Tachycardia Misdiagnosed as Supraventricular Tachycardia

Objective:To analyze the characteristics of clinical manifestations and electrophysiology of idiopathic left ventricular tachycardia (ILVT) originated from posterior ventricular septum and to investigate the reasons of misdiagnosis, as well as how to differentiate it from supraventricular tachycardia (SVT). Methods:5 patients hospitalized from 1999 to 2002 with ILVT were retrospectively analyzed (male 4, female 1, mean age 27 years old). The arrhythmia presented sudden onset and sudden termination without hemodynamic disturbance and could be terminated by verapamil in all patients who misdiagnosised as SVT with aberrant conduction in other hospitals.Results:In electrophysiological study, ventricular programming stimulation could induce ILVT with ventricle and atrium dissociation. ECG of tachycardia indicated right bundle branch block with left deviated or normal axis, sometimes combined with left anterior hemiblock. ILVT could not be induced after ablation of the earliest P potential within the posterior left ventricular septum. Conclusions: The clinical characteristic of ILVT was similar to that of SVT, and the contours of lead V1 and V6 of ECG were helpful to differentiate the two kinds of arrhythmia.