论文部分内容阅读
目的分析肺动脉瓣上起源的室性早搏(premature ventricular contractions,PVCs)心电图特征和导管消融经验。方法回顾性分析4例在华山医院成功行导管射频消融治疗肺动脉瓣上起源PVCs的资料。结果体表心电图平均QRS波宽度为(151±3)ms(146~154 ms),下壁导联振幅之和的平均值为(4.79±0.93)mV(3.76~5.64 mV)。3例下壁导联中Ⅲ导联振幅最高,2例avL/avR导联的QS比值大于1,3例胸导联移行为V4导联。2例标测过程中出现两种流出道起源图形的PVCs。4例成功导管射频消融靶点经造影证实位于肺动脉瓣上,肺动脉瓣上双极靶点电图领先体表心电图QRS波起点平均为(24±3)ms(22~28 ms),4例患者均消融即刻获得成功,无消融相关并发症发生,远期随访中位数22个月无复发。结论手术过程中出现多种右室流出道起源形态的PVCs要高度注意肺动脉瓣上起源可能,采用导管消融肺动脉瓣上起源PVCs安全、有效。
Objective To analyze the electrocardiographic features and catheter ablation experience of premature ventricular contractions (PVCs) originating from the pulmonary valve. Methods We retrospectively analyzed the data of 4 cases of successful PVCs originated from pulmonary valve in Huashan Hospital. Results The mean QRS amplitude of surface ECG was (151 ± 3) ms (146-154 ms) and the average amplitude of inferior leads was (4.79 ± 0.93) mV (3.76-5.64 mV). The amplitude of Ⅲ lead was the highest in 3 cases of inferior wall leads, and the QS ratio of 2 cases of avL / avR leads was greater than 1 and 3 cases of leads were V4 leads. Two cases of PVCs originated from the origin of the outflow tract appeared in two cases. Four of the successful catheterized radiofrequency ablation targets were located on the pulmonary valve by contrast-enhanced radiography. The onset of QRS in the leading surface ECG on the pulmonary valve was (24 ± 3) ms (22 to 28 ms) Immediate ablation were successful, no complications associated with ablation, long-term follow-up median of 22 months without recurrence. Conclusions During the operation, many PVCs with the origin form of right ventricular outflow tract appear to pay more attention to the origin of pulmonary valve. It is safe and effective to ablate PVCs originating from pulmonary valve by catheterization.