心电图表现为V_2导联R波缺失的流出道室性心律失常射频消融治疗的临床分析
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摘要
目的探讨流出道室性心律失常(VAs)心电图表现为V_2导联R波缺失(V_2导联R波小于V_1和V_3导联R波)患者的射频消融治疗效果。方法 2017年6月至2018年3月于北京安贞医院心内科就诊的因流出道VAs行射频消融治疗的82例无器质性心脏病患者中,纳入其中7例VAs心电图表现为V_2导联R波缺失的患者,均在三维标测系统指导下采用压力监测导管进行激动标测,并行射频消融治疗,分析其体表12导联心电图的QRS波群特征。结果所有患者均事先进行了右室流出道(RVOT)的激动标测,射频消融成功4例,均在RVOT前间隔消融成功,另外3例先后进行了RVOT、LVOT和冠状静脉激动标测,于左冠窦(LCC)消融成功1例,其余2例失败,1例无法深入心大静脉,另一例前室间静脉放电后患者疼痛,所有手术均无并发症发生,随访6个月5例即刻消融成功的患者无复发。结论心电图表现为V_2导联R波缺失的室性心律失常患者消融成功率偏低,标测的最早激动点位于RVOT、LCC和前室间静脉,消融成功的靶点位于RVOT前间隔和LCC。
Objective To investigate the therapeutic efficacy of radiofrequency ablation(RFA) in patients with outflow tract ventricular arrhythmias(OT-VAs) with manifestations of electrocardiogram(ECG) as R wave pattern break in lead V_2(PBV_2, R wave in lead V_2
Objective To investigate the therapeutic efficacy of radiofrequency ablation(RFA) in patients with outflow tract ventricular arrhythmias(OT-VAs) with manifestations of electrocardiogram(ECG) as R wave pattern break in lead V_2(PBV_2, R wave in lead V_2
引文
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[6]Komatsu Y,Nogami A,Shinoda Y,et al.Idiopathic Ventricular Arrhythmias Originating From the Vicinity of the Communicating Vein of Cardiac Venous Systems at the Left Ventricular Summit[J].Circ Arrhythm Electrophysiol,2018,11(1):e005386.
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[8]Yue-Chun L,Wen-Wu Z,Na-Dan Z,et al.Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus:results of radiofrequency catheter ablation in thirty-five patients[J].BMC Cardiovasc Disord,2012,12(?):32.doi:10.1186/1471-2261-12-32.
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[11]Enriquez A,Malavassi F,Saenz LC,et al.How to map and ablate left ventricular summit arrhythmias.Heart Rhythm,2017,14(1):141-8.
[12]Santangeli P,Hutchinson MD,Supple GE,et al.Right Atrial Approach for Ablation of Ventricular Arrhythmias Arising From the Left Posterior-Superior Process of the Left Ventricle[J].Circ Arrhythm El ectrophysiol,2016,9(7):e004048.DOI:10.1161/CIRCEP.116.004048
[13]宋艳东,李志忠,张京梅.心室流出道性室性心律失常的研究进展.中国循证心血管医学杂志,2018,10(11):1439-40.
[2]Kamakura S,Shimizu W,Matsuo K,et al.Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG[J].Circulation,1998,98(15):1525-33.
[3]Yamada T,McElderry HT,Doppalapudi H,et al.Idiopathic ventricular arrhythmias originating from the aortic root prevalence,electrocardiographic and electrophysiologic characteristics,and results of radiofrequency catheter ablation[J].J Am Coll Cardiol,2008,52(2):139-47.
[4]Ouyang F,Fotuhi P,Ho SY,et al.Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp:electrocardiographic characterization for guiding catheter ablation[J].J Am Coll Cardiol,2002,39(3):500-8.
[5]Yamada T,McElderry HT,Doppalapudi H,et al.Idiopathic ventricular arrhythmias originating from the left ventricular summit:anatomic concepts relevant to ablation.Circ Arrhythm Electrophysiol[J].2010,3(6):616-23.
[6]Komatsu Y,Nogami A,Shinoda Y,et al.Idiopathic Ventricular Arrhythmias Originating From the Vicinity of the Communicating Vein of Cardiac Venous Systems at the Left Ventricular Summit[J].Circ Arrhythm Electrophysiol,2018,11(1):e005386.
[7]Hayashi T,Santangeli P,Pathak RK,et al.Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2:A Distinct Clinical Entity.JCardiovasc Electrophysiol[J].2017,28(5):504-14.
[8]Yue-Chun L,Wen-Wu Z,Na-Dan Z,et al.Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus:results of radiofrequency catheter ablation in thirty-five patients[J].BMC Cardiovasc Disord,2012,12(?):32.doi:10.1186/1471-2261-12-32.
[9]Mc Alpine WA.Heart and Coronary Arteries[M].New York:SpringerVerlag.1975.
[10]Meredith MA,Hutchins GM,Moore GW.Role of the left interventricular sulcus in formation of interventricular septum and crista supraventricularis in normal human cardiogenesis[J].Anat Rec,1979,194(3):417-28.
[11]Enriquez A,Malavassi F,Saenz LC,et al.How to map and ablate left ventricular summit arrhythmias.Heart Rhythm,2017,14(1):141-8.
[12]Santangeli P,Hutchinson MD,Supple GE,et al.Right Atrial Approach for Ablation of Ventricular Arrhythmias Arising From the Left Posterior-Superior Process of the Left Ventricle[J].Circ Arrhythm El ectrophysiol,2016,9(7):e004048.DOI:10.1161/CIRCEP.116.004048
[13]宋艳东,李志忠,张京梅.心室流出道性室性心律失常的研究进展.中国循证心血管医学杂志,2018,10(11):1439-40.