摘要
目的 报道21例起源于左主动脉窦的室性心律失常的心电生理特征和射频消融疗效。方法 分析术前体表心电图（ECG）和Holter心电图室性早搏（VPB）或室性心动过速（VT）的形态特点，测量V1导联r波振幅和时限，计算r与QRS波的振幅和时限比值。术中在自发VPB或VT时标测主动脉窦，以局部室波最早部位放电消融，并进行冠状动脉造影，测量消融靶点距左冠状动脉口的距离。结果 21例均有频发VPB，8例有反复短阵VT。VPB或VT在Ⅱ、Ⅲ、aVF导联为高大R波，V1导联r波振幅为QRS波的1／3或以上，r波时限87．5±9．5ms，为QRS波时限的1／2以上。V3导联多为Rs形，V5、V6导联无S波。有效消融靶点局部电图室波明显超前ECG的QRS波（36．2±12．2ms），距左冠状动脉口部1cm左右。有效靶点放电2—8s VPB消失或VT终止。结论 起源于左主动脉窦的VPB或VT其Ⅱ、Ⅲ、aVF导联为高大R波，V1导联r波振幅高（≥1／3QRS波），时限宽（≥1／2QRS波）；主动脉窦激动顺序标测可安全有效地指导消融治疗。
Objective To report the electrocardiophysiological characteristics and ablation of ventricular tachyarrhythmia arising from the left aortic sinus of Valsava（LASV）in twenty-one patients. Methods The morphologic characteristics of ventricular premature beats （VPB） and ventricular tachycardia （VT） in ECG and Hoher were observed before ablation. The amplitude and duration of r waves in lead V1 were measured. The amplitude ratio and the duration ratio of r/QRS were also measured respectively. The potential of LASV was mapped during the onset of spontaneous VPB and VT in operation. Ablation was performed at the site with the earliest ventricular wave in regional electrograms. Then the selective coronary arteriography（SCA） was performed to measure the distance between the target of ablation and the debouch of left coronary. Results All of the 21 patients had frequently VPBs, 8 of them had recurrent bouts of short-term paroxymal VTs. VPBs or VTs in leads Ⅱ, Ⅲ, aVF showed tall R waves, and the amplitude of r wave in lead V1 reached or exceeded one third of the QRS complex. The average of r wave duration was 87.5±9.5 ms, which exceeded half of the QRS complex. A shape of Rs waves showed in lead V3 ,and there were no S wave in the lead V5 and V6. The earliest ventricular electrogram at a successful ablation site was recorded 36.2±12.2 ms before QRS onset and about 1 cm away from debouch of left coronary. VPBs and VT were eliminated after delivering of radiofrequency energy for 2-8 seconds at the target site. Conclusions VPBs and VT originated from LASV show tall R waves in leads Ⅱ , Ⅲ ,aVF, and high amplitude （ ≥ 1/3 of QRS complex） and wide duration （ ≥ 1/2 of QRS complex） of r waves in lead V1. The ablation can be safely and effectively performed in the guidance of activation mapping of the LASV.
出处
《中国心脏起搏与心电生理杂志》
2006年第1期38-41,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
电生理学
左室流出道室性心律失常
左主动脉窦
射频电流
导管消融
Electrophysiology
Left ventricular outflow tract tachyarrhythmia
Left aortic sinus of Valsalva
Catheter ablation, radiofrequency current
