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目的总结特发性左心室心动过速(ILVT)的体表心电图形态特点和电生理特点,探讨其误诊室上性心动过速(PSVT)并差异性传导(室上速并差传)的原因及两者的鉴别要点。方法选择进行了心内电生理和成功的导管射频消融术证实为ILVT且术前曾误诊为PSVT并差传的病例13例,回顾性分析ILVT的临床、体表心电图、心内电生理特点及导管射频消融治疗,对比分析PSVT并差传的心电图特点。结果ILVT和PSVT并差传的体表心电图均呈宽QRS形心动过速,伴有右束支传导阻滞(RBBB)或伴类RBBB特征。ILVT的心电轴左偏或重度右偏,其QRS波群呈类RBBB图形,V1导联有“兔耳征”者11例,13例均呈I、V5、V6的S波宽但顶峰呈尖锐状,不粗钝无明显切迹,V6导联R/S<1者12例。起源于心室间隔部及左室心尖部9例,其体表心电图上Ⅱ、Ⅲ、avF均以S波为主,起源于左室流出道和左室游离壁近心底部4例,其Ⅱ、Ⅲ、avF以R波为主。电生理特点:13例均可诱发及中止,室速时呈VA分离或1:1VA传导、2:1VA传导,心室刺激可拖带心动过速。用激动标测与起搏标测方法标测靶点进行射频消融治疗全部获得即刻成功,2例术后复发。结论体表心电图鉴别ILVT和PSVT并差传有其独特性和局限性,电生理检查是明确诊断的手段,导管射频消融治疗为首选治疗方法。
Objective To summarize the morphological characteristics and electrophysiological characteristics of surface electrocardiogram (ECG) of idiopathic left ventricular tachycardia (ILVT), and to explore the causes of misdiagnosed supraventricular tachycardia (PSVT) and differential conduction (supraventricular tachycardia and differential transmission) And the identification of the two points. Methods Thirteen cases of intracardiac electrophysiology and successful catheter radiofrequency ablation confirmed as ILVT and preoperatively misdiagnosed as PSVT and differential transmission were retrospectively analyzed. The clinical, electrocardiographic and intracardiac electrophysiological characteristics of ILVT were retrospectively analyzed. Catheter radiofrequency ablation, comparative analysis of PSVT and ECG transmission characteristics. Results The body surface electrocardiogram of both ILVT and PSVT with differential transmission showed wide QRS tachycardia with right bundle branch block (RBBB) or concomitant RBBB. ILVT ECG left or right deviation, the QRS wave group showed RBBB graphics, V1 lead “rabbit ear syndrome” in 11 cases, 13 cases were I, V5, V6 S wave width but the peak was Sharp, not rough no significant notch, V6 lead R / S <1 in 12 cases. Originated in the ventricular septum and left ventricular apex in 9 cases, the body surface electrocardiogram Ⅱ, Ⅲ, avF are S wave, originated in the left ventricular outflow tract and the left ventricular free wall in the bottom of the proximal 4 cases, Ⅱ, Ⅲ, avF mainly R wave. Electrophysiological characteristics: 13 cases can be induced and stopped, ventricular septal VA separation or 1: 1VA conduction, 2: 1VA conduction, ventricular stimulation can be towed tachycardia. Targeted excitability mapping and pacing mapping method for radiofrequency ablation all received immediate success, 2 cases of postoperative recurrence. Conclusion Body surface electrocardiogram to identify ILVT and PSVT and differential transmission has its uniqueness and limitations, electrophysiological examination is a clear diagnostic tool, catheter radiofrequency ablation is the preferred treatment.