右室心尖部起搏时体表心电图V1导联呈右束支阻滞图形分析

目的分析右室心尖部起搏患者V1导联呈现右束支阻滞图形的特点、出现的可能机制以及鉴别诊断方法。方法选取北京大学人民医院2005—2007年于右室心尖部植入起搏电极的患者,分析患者完全右室起搏时V1导联呈右束支阻滞图形患者的超声心动图、胸部X线等资料,并与同期V1导联呈左束支阻滞图形变化的右室起搏患者以及植入左室心外膜电极的患者的临床资料以及体表心电图特点进行对比。结果共有9例患者术后完全心室起搏时V1导联呈右束支阻滞图形,术后超声心动图以及胸部X线检查证实起搏电极均位于右心室,QRS波平均电轴为-61.7±15.6,与随机选取50例术后体表心电图呈左束支阻滞的右室电极植入患者心电图相比,QRS波电轴差异无统计学意义(P>0.05),与7例行左室心外膜起搏者QRS波电轴差异有统计学意义(P<0.05)。呈右束支阻滞者其肢体导联I、aVL导联QRS波均直立,与呈左束支阻滞患者相同,而左室心外膜起搏者其I、aVL导联QRS波为负向。结论当患者V1导联呈右束支阻滞形态时可通过I、aVL导联QRS波形态和QRS波电轴可以判断是否为右室起搏。

The analysis for the right bundle branch block configuration in surface electrocardiograph V1 lead during right ventricular apex pacing.

Objective To analyze surface electrocardiography(ECG)characteristics,mechanisms and differential methods of right bundle branch block(RBBB)configuration in the patients who underwent right ventricular apex pacing.Methods In the patients who were implanted right ventricular leads or left ventricular epicardium lead,the parameters of ECG,ultracardiograph,and chest X-ray were compared in the patients with or without RBBB configuration.Results There were 9 patients who had RBBB configuration in V1 lead,but the test of UCG and X-ray were normal.The QRS axis and the configuration in lead I,aVL had no significant difference in the patients with or without RBBB configuration,but had significant difference between the patients with right ventricular pacing and with left ventricular pacing.Conclusion The QRS axis and the configuration in lead I,aVL can be used as the differential index when the patients undergo right pacing.