左心室流出道特发性室性心动过速的心电图特征与射频导管消融术治疗(摘要)
作者：马长生 周玉杰 颜红兵 王勇 刘兴鹏 张薇 董建增 刘旭 孙英贤 张存泰
单位：北京市，中日友好医院 心内科(100029) 马长生 周玉杰 颜红兵 王勇 刘兴鹏；山东医科大学附属医院 张 薇(第三作者)；河南医科大学第一附属医院 董建增(第四作者)；上海胸科医院 刘 旭(第五作者)；中国医科大学第一临床学院 孙英贤；同济医科大学附属同济医院 张存泰
关键词：
目的 目的：分析总结左心室流出道(LVOT)特发性室性心动过速的临床特点、体表心电图特征、心内电生理标测及射频导管消融术的方法与效果。
方法：10例LVOT特发性室性心动过速患者，年龄30.4±20.2(11～61)岁,病史6个月～9年。根据心室激动顺序标测和(或)起搏标测的结果选择消融靶点，输出功率10～40 W。所有患者行冠状动脉造影确定左右冠状动脉开口及主动脉窦位置关系后进行射频消融。
, http://www.100md.com
结果：10例患者均呈宽QRS心动过速，发作时12导联心电图具有特征性变化：Ⅰ导联呈现rs或QS形，aVL导联为QS波，Ⅱ、Ⅲ、aVF导联呈高尖R形，根据胸前导联形态LVOT室性心动过速可分为三种类型的心电图表现：第一种类型(5例)V1呈Rs或RS，V2呈rS形，V3～V6均呈Rs或R波；第二种类型(3例)V1，V2呈rS形，V3～V6呈Rs型；第三种类型(2例)V1～V6均呈R波。9例消融成功，其中8例采取激动顺序标测于主动脉左窦内消融成功，成功消融靶点V波比VT的QRS波起点提前36.1±14.0(24～66)ms，1例于主动脉瓣下5 mm处消融成功；失败1例。平均放电时间为93±22(45～150)秒，自放电至室性心动过速终止时间为2.01±1.47(0.5～4.2)秒。术中无并发症，随访1～18个月无复发。
, 百拇医药
结论：射频导管消融治疗LVOT特发性室性心动过速的成功率高；LVOT特发性室性心动过速具有特征性的体表心电图表现，其起源点多位于主动脉左窦内，射频导管消融术中应注意防止损伤冠状动脉及主动脉瓣。
Electrocardiographic Features and Effect of Radiofrequency Ablation in Idiopathic Ventricular Tachycardia Originated from the Left Ventricular Outflow Tract(Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhou Yujie, Zhang Wei, et al.
, 百拇医药
Objective: Idiopathic ventricular tachycardia (VT) originated from the left ventricular outflow tract (LVOT) is rare. This study was performed to analyse the clinical features, characteristics of body surface electrocardiogram (ECG), methods of electrophysiologic mapping and results of radiofrequency (RF) ablation in idiopathic ventricular tachycardia (VT) originated from the left ventricular outflow tract.
Methods: Electrophysiological studies (activation mapping or pacing mapping) and RF ablation were performed in 10 cases (6 males and 4 females, mean age 30.0±20.2 years) of idiopathic LVOT VT. The patients had a history of VT ranged from 9 months to 61 years. RF current output of 10 to 40 W was delivered to the target sites. Before application of the RF energy, coronary angiography was performed to determine the ostium of coronary artery and the location of Valsalva′s sinus in all patients.
, 百拇医药
Results: Body surface ECG during VT showed wide QRS morphology in all patients. The specific electrocardiographic characteristics of QRS morphology in 12-lead ECG included: rs or QS pattern in leads I, QS pattern in aVL and a tall R wave in Ⅱ, Ⅲ and aVF. There were 3 types of QRS morphology in the precordial leads: ① Rs or RS pattern in V1, rS pattern in V2, Rs or R wave pattern in V3-6 (5 cases). ② rS pattern in V1-2 and Rs pattern in V3-6 (3 cases); R/s>1 in V1， rS in V2， R in V3-6. ③ Monomorphic R wave pattern in V1-6 (2 cases). RF ablation was successful in 9 patients. In 8 patients, the successful target sites were located in left Valsalva′s sinus and the ealiest activation at these sites preceded the onset of QRS complex on surface ECG by 36.1±14.0 (range 24 to 66) ms during activation mapping. One patient got success at a 5 mm site under the aortic valve. The mean RF current delivery time was 93±22 (range 45 to 150) seconds. Time between the onset of RF and termination of VT was 2.01±1.47 (range 0.5 to 4.2) seconds. There were no complications during the procedure and no recurrence during the follow-up period (1 to 18 months).
Conclusions: ① RF ablation of idiopathic VT originated from LVOT has high success rate. ② Idiopathic VT originated from LVOT has specific electrocardiographic characteristics. ③ The most common origin site of this kind of VT is left Valsalva′s sinus and extreme caution is advisable when applying RF energy to this site., http://www.100md.com
单位：北京市，中日友好医院 心内科(100029) 马长生 周玉杰 颜红兵 王勇 刘兴鹏；山东医科大学附属医院 张 薇(第三作者)；河南医科大学第一附属医院 董建增(第四作者)；上海胸科医院 刘 旭(第五作者)；中国医科大学第一临床学院 孙英贤；同济医科大学附属同济医院 张存泰
关键词：
目的 目的：分析总结左心室流出道(LVOT)特发性室性心动过速的临床特点、体表心电图特征、心内电生理标测及射频导管消融术的方法与效果。
方法：10例LVOT特发性室性心动过速患者，年龄30.4±20.2(11～61)岁,病史6个月～9年。根据心室激动顺序标测和(或)起搏标测的结果选择消融靶点，输出功率10～40 W。所有患者行冠状动脉造影确定左右冠状动脉开口及主动脉窦位置关系后进行射频消融。
, http://www.100md.com
结果：10例患者均呈宽QRS心动过速，发作时12导联心电图具有特征性变化：Ⅰ导联呈现rs或QS形，aVL导联为QS波，Ⅱ、Ⅲ、aVF导联呈高尖R形，根据胸前导联形态LVOT室性心动过速可分为三种类型的心电图表现：第一种类型(5例)V1呈Rs或RS，V2呈rS形，V3～V6均呈Rs或R波；第二种类型(3例)V1，V2呈rS形，V3～V6呈Rs型；第三种类型(2例)V1～V6均呈R波。9例消融成功，其中8例采取激动顺序标测于主动脉左窦内消融成功，成功消融靶点V波比VT的QRS波起点提前36.1±14.0(24～66)ms，1例于主动脉瓣下5 mm处消融成功；失败1例。平均放电时间为93±22(45～150)秒，自放电至室性心动过速终止时间为2.01±1.47(0.5～4.2)秒。术中无并发症，随访1～18个月无复发。
, 百拇医药
结论：射频导管消融治疗LVOT特发性室性心动过速的成功率高；LVOT特发性室性心动过速具有特征性的体表心电图表现，其起源点多位于主动脉左窦内，射频导管消融术中应注意防止损伤冠状动脉及主动脉瓣。
Electrocardiographic Features and Effect of Radiofrequency Ablation in Idiopathic Ventricular Tachycardia Originated from the Left Ventricular Outflow Tract(Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhou Yujie, Zhang Wei, et al.
, 百拇医药
Objective: Idiopathic ventricular tachycardia (VT) originated from the left ventricular outflow tract (LVOT) is rare. This study was performed to analyse the clinical features, characteristics of body surface electrocardiogram (ECG), methods of electrophysiologic mapping and results of radiofrequency (RF) ablation in idiopathic ventricular tachycardia (VT) originated from the left ventricular outflow tract.
Methods: Electrophysiological studies (activation mapping or pacing mapping) and RF ablation were performed in 10 cases (6 males and 4 females, mean age 30.0±20.2 years) of idiopathic LVOT VT. The patients had a history of VT ranged from 9 months to 61 years. RF current output of 10 to 40 W was delivered to the target sites. Before application of the RF energy, coronary angiography was performed to determine the ostium of coronary artery and the location of Valsalva′s sinus in all patients.
, 百拇医药
Results: Body surface ECG during VT showed wide QRS morphology in all patients. The specific electrocardiographic characteristics of QRS morphology in 12-lead ECG included: rs or QS pattern in leads I, QS pattern in aVL and a tall R wave in Ⅱ, Ⅲ and aVF. There were 3 types of QRS morphology in the precordial leads: ① Rs or RS pattern in V1, rS pattern in V2, Rs or R wave pattern in V3-6 (5 cases). ② rS pattern in V1-2 and Rs pattern in V3-6 (3 cases); R/s>1 in V1， rS in V2， R in V3-6. ③ Monomorphic R wave pattern in V1-6 (2 cases). RF ablation was successful in 9 patients. In 8 patients, the successful target sites were located in left Valsalva′s sinus and the ealiest activation at these sites preceded the onset of QRS complex on surface ECG by 36.1±14.0 (range 24 to 66) ms during activation mapping. One patient got success at a 5 mm site under the aortic valve. The mean RF current delivery time was 93±22 (range 45 to 150) seconds. Time between the onset of RF and termination of VT was 2.01±1.47 (range 0.5 to 4.2) seconds. There were no complications during the procedure and no recurrence during the follow-up period (1 to 18 months).
Conclusions: ① RF ablation of idiopathic VT originated from LVOT has high success rate. ② Idiopathic VT originated from LVOT has specific electrocardiographic characteristics. ③ The most common origin site of this kind of VT is left Valsalva′s sinus and extreme caution is advisable when applying RF energy to this site., http://www.100md.com