双源CT精确判断的室间隔起搏患者心电图变化特征

目的结合数字减影血管造影(DSA)图像以及双源CT精确判定室间隔起搏部位,分析体表心电图变化特征。方法 57例植入起搏器患者,术中经DSA图像定位提示起搏导线植入右室间隔部,术后行双源CT确定导线精确位置,分析明确植入到室间隔不同部位及游离壁的起搏心电图特征。结果游离壁12例(21.1%);间隔45例(78.9%)。游离壁起搏的QRS波时限显著宽于高位间隔起搏(150±15 ms vs 121±26 ms,P<0.05);高位间隔起搏Ⅲ导联R波振幅(RⅢ)明显大于低位间隔起搏(1.10±0.55 mV vs-0.27±0.12 mV,P<0.05);高位间隔起搏者44.4%Ⅰ导联出现q波或QS,中位间隔36.8%,低位和游离壁均为0;代表游离壁起搏的肢体导联切迹发生率没有明显差异。结论室间隔起搏心电图往往表现为窄QRS波,I导联形态多变,高位间隔起搏时RⅢ较高。

The electrocardiographic characterictics of septum pacing located by double source computerized tomography accurately

Objective To investigate the electrocardiographic characterictics of septum pacing which were located by digital subtraction angiography(DSA) image and double source computerized tomography(DSCT).Methods Fifty-seven patients were enrolled in this study,and they were received the DSCT examination at post-operation of pacemaker implatation.Then ECGs of those patients were analyzed.Results The leads were implanted on the free wall of right ventricular in 12 patients(21.1%),and on the ventricular septum of right ventricular in 45 patients(78.9%).The durations of the QRS wave in free wall group are longer than those in high septum pacing group(150±15 ms vs 121±26 ms,P<0.05);The R wave amplitude of lead Ⅲ in high-septum group was dramatically larger than those in low-septum group(1.10±0.55 mV vs-0.27±0.12 mV,P<0.05);About 44.4% lead I in high-septum group and 36.8% lead I of mid-septum were of a q-wave or of negative QRS,and other two groups had none of a q-wave or of negative QRS.Conclusion The electrocardiography of ventricular septum pacing usually shows a narrow QRS duration,wave of lead I has polytropic shapes,the amplitude of lead Ⅲ R wave of high-sepum group is higher than that of the low septum group.