起源于主动脉窦内反复单形室性心动过速和/或频发室性早搏的心电图特征及射频消融治疗

探讨起源于主动脉窦内的反复单形室性心动过速(简称室速)和/或频发室性早搏(简称室早)的心电图特点和射频消融治疗。分析35例该类患者的室速和频发室早的心电图、心内电生理检查和射频消融治疗情况。结果:室性心律失常起源于左冠状动脉窦(简称左冠窦)的30例、无冠状动脉窦3例和主动脉根部左冠窦下2例。左冠窦的心电图特点:Ⅰ和aVL导联为rs、rS或QS波形,Ⅱ、Ⅲ和aVF导联为R波形,胸导联R波移行区在V2或V3导联,V5、V6导联为高振幅R波,无S波;V2导联R高度/S高度比值1.29±0.36。主动脉根部左冠窦下起源的心电图特点:和左冠窦起源室性心律失常的心电图特点基本相同,但V5、V6导联有S波。无冠状动脉窦起源的心电图特点:Ⅰ和aVL导联为Rs或R波形,Ⅱ、Ⅲ和aVF导联为R波形,胸导联R波移行区在V3导联。34例消融成功,手术操作时间65~120min,X光曝露时间12~30min。1例出现冠状动脉前降支急性闭塞。随访2~53个月,无复发病例。结论:起源于主动脉窦内的室速和/或频发室早有其独特的心电图表现,射频消融能安全、有效地根治此类心律失常。

Electrocardiographic Characteristics and Radiofrequency Catheter Ablation of Ventricular Tachycardia and Ventricular Premature Contractions Originating From the Aortic cusp

We sought to investigate the electrocardiographic(ECG) characteristics and asses s the results of radiofrequency catheter ablation(RFCA) of ventricular tachycardia (VT) or ventricular premature contractions(VPCs) originating from the left aortic sinus cusp(ACS). Twelve-lead ECG analysis, electrophysiologic study and RFCA were performed in 3 5 normal heart patients with VT or VPCs originating from ACS. Results: Arrhythmia orignating fr om left ACS, the surface ECG analysis revealed rs, rS or QS wave on lead Ⅰ and aVL, tall R wave on lead Ⅱ, Ⅲ and aVF, tall R wave on lead V5 and V_6 but no S wave on either lead V_5 or V_6. Precordial R wave transition occurred on lead V_1, V_2 or V_3. The mean R/S wave amplitude on lead V_2 wa s 1.29±0.36(range 0.80 to 2.83). For arrhythmia orignating from under left ACS, the surface ECG ha ve same characterictics but with S wave on lead V_5 and V_6. The surface ECG analysis revealed Rs or R wave on lead Ⅰ and aVL, tall R wave on lead Ⅱ, Ⅲ and aVF. Precordial R wave t ransition occurred on lead V_3 during arrhythmia orignating from posterior ACS. With acti vation and pacing mapping, 34 of 35 patients with VT or VPCs were successfully abolished. The procedure tim e was 65~120 min and the fluoroscopic time was 12~30 min.The left anterior descending acute o cclusion was occurred in one patient. None recurrenced during follow-up. Conclusions: The specific ECG characteristics of VT or VPCs originating from the left ASC are hel pful for guiding RFCA. This arrhythmia can be successfully and safely abolished.