单导管射频消融治疗三尖瓣环起源的室性心律失常临床分析

目的探讨三尖瓣环起源的特发性室性早搏和／或室性心动过速（PVCs/VT）的体表心电图特点及单导管射频导管消融治疗的疗效与安全性。方法选取20例特发性三尖瓣环起源的PVCs/VT患者，所有患者均予以单导管射频消融治疗，分析其体表12导联心电图的QRS波群特征及其变化规律，并对起源于三尖瓣环游离壁的PVCs/VT起源部位的时钟点数与体表12导联心电图的r（R）波高度及s（S）波深度相关性进行分析。结果消融成功19例（95．0％），均无并发症发生，失败1例。其中17例消融成功、起源于三尖瓣环游离壁PVCs/VT的心电图特征存在下列变化规律：由三尖瓣环后侧壁→侧壁→前侧壁，下壁导联的r（R）波逐渐增高，而S（S）波逐渐变浅甚至消失，同时r或R波呈Ⅱ〉aVF〉Ⅲ、S或S波呈Ⅲ〉aVF〉Ⅱ的变化趋势；aVL导联的R波逐渐变浅；aVR导联的QS波逐渐变深；三尖瓣环游离壁PVCs和／或VT者下壁导联的r（R）波高度与其起源的时钟点数呈正相关（P〈0．05），而s（S）波深度、aVL导联的R波高度及aVR导联的QS波深度与其起源的时钟点数呈负相关（P〈0．05）。结论起源于三尖瓣环的PVCs/VT是特发性PVCs/VT的一个亚组，单导管射频消融治疗是安全有效的，三尖瓣环不同起源PVCs/VT的心电图特征亦异且有一定的变化规律，掌握其体表心电图特点将有助于消融术前初步判定其起源部位。

Single-catheter approach of radiofrequency ablation for idiopathic premature ventricular contractions originating from tricuspid annulus

Objective To evaluate the safety and clinical effects of single-catheter approach to radiofrequency ablation （SCARF） in treatment of idiopathic premature ventricular contraction and ventricular tachycardia （PVC/VT） originating from the tricuspid annulus. Methods Twenty patients aged 14 to 70 （32.0 ± 16.6） with idiopathic PVCs/VT originating from the tricuspid annulus underwent radiofrequency ablation with single catheter. The characteristics of 12-lead electrocardiogram （ECG） were analyzed, and the correlation of r （R） wave height or s （S） wave depth of 12-lead electrocardiogram with the clock＇s counts of PVCs/VT originating from the tricuspid annulus free wall was analyzed by linear regression. Results Operations were performed smoothly with a ablation successful rate of 95.0% （19/20） and there were no ablation related complications. According to effective target 18 PVCsNT was originated from the free wall of the tricuspid annulus and the remaining 2 from anteroseptal portion of the tricuspid annulus. Further analysis found that the r （R） wave was higher and s （S） wave shallower from behind wall to side wall and front wall in leads Ⅱ , Ⅲ and aVF, the R wave were shallower in lead aVL and the QS wave were deeper in lead aVR. Linear regression analysis revealed that the r （R） wave height in leads behind wall was positively correlated with the clock＇s counts of origin （P〈0.05）, and the s （S） wave depth in leads behind wall, R wave height in lead aVL QS wave depth in lead aVR were negatively correlated with the clock＇s counts（ P〈0.05 ）. Conclusion The single-catheter approach of radiofrequency ablation is safe and effective in treatment of tricuspid annular PVCs/VT. The electrocardiographic patterns are different at the different sites of origin of PVCs/VT, and the origin of the idiopathic PVCs/VT can be determined by ECG analysis.