源自右室流出道室性早搏的心电图定位分析

第19卷第1期2010年1月

vol.19No.1Jan.2010武警医学院学报Acta Academiae Medicinae CPAF [收稿日期]2009-05-25;[修回日期]2009-10-23

[作者简介]时向民（1970-），男，籍贯天津，医学博士，副主任医师，主要从事心脏电生理研究。源自右室流出道室性早搏的心电图定位分析

时向民1，王玉堂2，单兆亮2，杨庭树1（解放军总医院：1.南楼心内科；2.心内科；北京100853）

摘要:【目的】分析右室流出道（RVOT ）起源室性早搏的心电图特征及其与消融靶点的关系,探讨RVOT 室性早搏有效准确的心电图定位方法。【方法】回顾分析2001-2008年在我院行射频消融的RVOT 室性早搏62例，依据成功消融靶点X 线定位结果，分析其与心电图各项指标的关系。【结果】在RVOT 早搏中，游离壁与间隔部起源相比Ⅱ，Ⅲ，AVF 导联R 波宽伴有切迹（P <0.05）。Ⅰ导联呈QS 或rsr’提示室早源自RVOT 前部，呈R 或rR 则起源于后部，（P <0.05）。Ⅱ，Ⅲ，AVF 导联R 波越高（P <0.05），胸前导联R/S 移行越早（P <0.05）提示早搏距离肺动脉瓣越近。【结论】在RVOT 起源的室早中Ⅱ，Ⅲ，AVF 导联R 波宽度判断早搏源于间隔或游离壁，Ⅰ导联QRS 波形态判断早搏源于RVOT 前部或后部，Ⅱ，Ⅲ，AVF 导联R 波高度结合胸前导联R/S 移行判断早搏接近肺动脉瓣或三尖瓣。

关键词:室性早搏；右室流出道；心电图；射频消融

【文章编号】1008-5041(2010)01-0029-03【中图分类号】R540.4【文献标识码】A

ECG analysis of ventricular premature contraction originating from right ventricular outflow tract

SHI Xiang-min,WANG Yu-tang,SHAN Zhao-Liang,YANG Ting-shu (Department of Cardiology of South Building,General Hospital of PLA,Beijing 100853,China)

Abstract:【Objective 】To analyze the relationship between ECG and target ablation site of ventricular premature contraction (VPC)originated from right ventricular outflow tract (RVOT)and to investigate the effective method to localize the VPC origination.

【Methods 】62patients(pts)hospitalized for radiofrequency ablation within 2001to 2008with VPC from RVOT were retrospectively analyzed,Correlative relation between successful ablation site based on X ray films and a variety of ECG parameters were studied.

【Results 】In VPC from RVOT,wide and notched R wave of Ⅱ，Ⅲ，AVF indicated VPC originating from free wall (P <0.05),QS or rsr’type in lead Ⅰsuggested VPC originating from anterior wall,R or rR type indicated posterior wall origination (P <0.05).high R wave in Ⅱ，Ⅲ，AVF (P <0.05)with early R/S transition(P <0.05)revealed VPC adjacent to pulmonary valve.【Conclusions 】In VPC from RVOT the width of R wave in lead Ⅱ，Ⅲ，AVF was sensitive to localize VPC from free wall or septal.QRS configuration in lead Ⅰwas of use to distinguish VPC from anterior or posterior part within RVOT.The amplitude of R wave in lead Ⅱ，Ⅲ，AVF combined with R/S transition in precordial lead could predict VPC adjacent to pulmonary valve or tricuspid valve.

key words:Ventricular premature contraction;Right ventricular outflow tract;ECG;Radiofrequency ablation

右室流出道起源的室性早搏临床较为多见，患

者多不伴器质性心脏病。其发病机制可能与儿茶

酚胺介导的晚期后除极以及局部微折返有关[1]。该

部位起源的频发室早或室速射频消融治疗虽然具

有较高的成功率，但普遍存在寻找靶点时间较长，

无效放电次数多，X 线曝光时间长的特点。如能根据心电图特征预先判断早搏的起源位置，在标测时预见性的在流出道某一区域寻找靶点，对于提高手术效率，缩短手术时间至关重要。本研究分析2001-2008年在我院行射频消融的62例右室流出道室早心电图特点，结合成功靶点X 线定位，总结了该部位早搏的心电图定位特点。

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