心室流出道频发室性早搏、室性心动过速的心电图特征及射频消融治疗

目的探讨心室流出道频发室性早搏和/或室性心动过速的心电图特征及射频消融治疗的有效性及安全性。方法对14例(13例右心室流出道频发室性早搏和/或室性心动过速,1例左心室流出道频发室性早搏)的心电图特征进行分析并行射频消融治疗。结果右心室流出道室性早搏及室性心动过速体表12导联心电图QRS波特征:Ⅰ导联呈rs、m、QS及R型,aVRa、VL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、V3导联之后,V1、V2导联R高度/S高度比值常<0.3。左心室流出道频发室性早搏和/或室性心动过速的QRS波特征与右心室流出道频发室性早搏和/或室性心动过速类似,但其胸前导联R波移行区常在V2导联之前,V1、V2导联(尤其V2导联)R高度/S高度比值常≥0.8。13例消融成功,手术操作时间45~156min,X线曝光时间8~28min。术后随访2~36个月,无复发病例。结论起源于心室流出道的频发室性早搏和/或室性心动过速有其独特的心电图表现,射频消融治疗能安全、有效地根治此类心律失常。

Electrocardiographic Characteristics and Radiofrequency Catheter Ablation in Ventricular Tachycardia and Ventricular Premature Contractions Originating from the Oufflow Tract

Objective To investigate the electrocardiographic characteristics and assess the efficiency and safety of radiofrequency catheter ablation in ventricular tachycardia and ventricular premature contractions originating from the outflow tract.Methods The electrocardiographic characteristics and the results of radiofrequency catheter ablation were anayzed in 14 cases(13cases ventricular tachycardia and ventricular premature contractions originating from right outflow tract and 1 case ventricular premature from left outflow tract).Results The surface electrocardiogram of ventricular tachycardia and ventricular premature contractions originating from right outflow tract showed rs,m,QS or R wave on lead I.QS wave was seen on lead aVR and aVL.Tall R wave was seen on lead Ⅱ,Ⅲ,aVF,V_5 and V_6.Precordial lead R wave transition occurred on lead V_3 or behind it.The mean R/S wave amplitude on lead V_1 and V_2 was<0.3.The surface electrocardiographic characteristics of ventricular premature contractions originating from left outflow tract were similar with above.But the precordial lead R wave transition was earlier than that on lead V_2. The mean R/S wave amplitude on lead V_1 and V_2 was≥0.8.13 of 14 patients with ventricular tachycardia and ventricular premature contractions were successfully abolished.The procedure time was 45-156 min and the fluoroscopic time was 8-28 min.During follow-up,there was no recurrence.Conclusions There are specific electrocardiographic characteristics in ventricular tachycardia and ventricular premature contractions originating from the outflow tract.The arrhythmia can be successfully and safely abolished by radiofrequency catheter ablation.