起源点邻近主动脉瓣和二尖瓣交界处的特发性室性心律失常心电图特点及射频消融治疗

摘要

Objective To evaluate the electrocardiographic (ECG) characteristics and effects of ra-diofrequency catheter ablation ( RFCA) in patients with idiopathic ventricular tachycardia ( IVT) or premature ventricular contraction (PVC) originating from the aortomitral continuity (AMC).Methods 868 IVT/PVC patients received RFCA from May 2009 to Oct 2014 , among whom 19 patients were diagnosed as VT/PVC originated in AMC.The 12 leads (ECG) characteristics of the AMC VT/PVC were analyzed.Results The 12-lead ECG patterns of AMC originated VT/PVC were characterized by: R wave in lead V1 , R/S transition pattern (zone) in V1 leads, Rs wave in lead V2-V3(or V4), rs wave in lead Ⅰ, high R wave in lead Ⅱ、Ⅲ、aVF with R wave rise and fall section symmetry , RⅢ≥RⅡ, and QS wave in both lead aVR and aVL .The IVT/PVCs were successfully eliminated by RFCA in 18 cases.The VT/PVCs were originated from the aortomi-tral continuity in the 18 cases.RFCA failed in one case.Conclusion IVT/PVC originated in AMC was a dis-tinct subgroup of IVT/PVC which can be successfully treated by RFCA .12-leads ECG analysis is a powerful tool in determining the exact origin of these IVT/PVC.%目的：评估起源点邻近主动脉瓣和二尖瓣交界处（ AMC）附近的室性心动过速／室性早搏（室速／室早）的心电图特点及射频消融治疗效果。方法武汉亚洲心脏病医院心内科2009年5月至2014年10月868例室性心律失常患者行电生理检查（ EPT）和射频消融术（ RFCA），其中19例患者被确诊为AMC起源的室速／室早，对该19个病例室速／室早12导联心电图进行形态分析。结果对19例AMC处起源的室速／室早心电图做进一步分析，发现特点如下：V1导联均呈R形，胸前导联R波在V1移行，V2～V3（或V4）导联均为Rs波，V5～V6导联均为R波，无s波，Ⅰ导联为rs型，Ⅱ、Ⅲ、aVF导联均为正向大R波，RⅢ≥RⅡ，R波升支和降支斜度相对对称。 AVR和AVL导联为QS型。其中18例室速／室早术中消融成功，均起源于主动脉瓣与二尖瓣交界处，1例室早消融失败。结论起源点邻近AMC处附近的室速／室早是IVT／PVC的一个亚组，射频消融治疗可取得良好效果，掌握其体表心电图特点有助于判定室速／室早的起源部位。