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目的分析经主动脉窦消融成功的室性心律失常体表心电图特点。方法 36例频发室性早搏/非持续性室性心动过速(PVCs/NSVT)的患者经主动脉逆行途径,在CARTO三维电解剖标测指导下,在主动脉根部-左室流出道衔接部进行三维解剖重建、激动顺序标测和指导消融,且消融成功(1例部分成功),并分析其体表心电图特点。结果 36例患者,经左冠窦消融成功30例(83.3%),右冠窦6例(16.7%)。PVCs在体表心电图均表现心电轴下偏的反复单一形态的QRS波形。经左冠窦消融成功的PVCs/NSVT,Ⅰ导联为R、Rs、rS、r、q或rsr波,Ⅱ、Ⅲ、aVF导联均为高振幅R波,胸前导联PVCs R波移行区位于V_1~V_3导联,且PVCs移行区均早于窦性心律移行区,V_1导联表现为R、Rs、RS、rS或qr波,V_1或V_2导联R/S波幅指数2.64±2.03,R波时限指数0.62±0.12,Ⅲ导联与Ⅱ导联R波振幅比(RⅢ/RⅡ)1.09±0.18,aVL导联与aVR导联QS波振幅比(QSaVL/QSaVR)1.32±0.46。经右冠窦消融成功的PVCs/NSVT,Ⅰ导联为R、Rs、r波,Ⅱ、Ⅲ、aVF导联均为高振幅R波,胸前导联PVCs R波移行区位于V_1~V_3导联,V_1导联表现为R、Rs、rS波,V_1或V_2导联R/S波幅指数0.51±0.38,R波时限指数0.55±0.26,RⅢ/RⅡ0.95±0.23,QSaVL/QSaVR1.12±0.39。PVCs经左冠窦消融成功的V_1或V_2导联R/S波幅指数要高于右冠窦(P<0.05)。结论经左冠窦消融成功的室性心律失常多于右冠窦。体表心电图的相关特征有助于决策主动脉窦内的室性心律失常的具体消融部位。
Objective To analyze the characteristics of epicardial electrocardiogram (ECG) of ventricular arrhythmias after aortic sinus ablation. Methods Thirty-six patients with frequent premature ventricular contractions / non-sustained ventricular tachyarrhythmias (PVCs / NSVT) underwent aortic retrograde approach under the guidance of CARTO three-dimensional electroanatomic mapping in aortic root-left ventricular outflow tract Department of anatomical reconstruction of three-dimensional, activation sequence mapping and guidance of ablation, and the successful ablation (one case of partial success), and analysis of the surface ECG characteristics. Results In the 36 patients, 30 cases (83.3%) had successful ablation of the left coronary artery and 6 cases (16.7%) had right coronary sinus. PVCs in the body surface ECG showed ECG axis deviation of the repeated single QRS waveform. The PVCs / NSVTs successfully obtained by left coronary sinus ablation, the lead Ⅰ is R, Rs, rS, r, q or rsr wave, the Ⅱ, Ⅲ, aVF leads are high amplitude R wave, The areas of V_1 ~ V_3 leads are earlier than that of sinus rhythm. The V_1 lead shows R, Rs, RS, rS or qr waves, and the R / S index of V_1 or V_2 lead is 2.64 ± 2.03 , The R wave duration index was 0.62 ± 0.12, the R wave amplitude ratio (R Ⅲ / RⅡ) between lead III and lead II was 1.09 ± 0.18, and the QS wave amplitude ratio between aVL lead and aVR lead was (1.32 ± 0.46). PVCs / NSVTs successfully obtained via right coronary sinus ablation were lead R, Rs and r, and lead R, R and R were all high-amplitude R waves. PVCs R-wave transition in the precordial leads was located at V_1-V_3 The V_1 lead showed R, Rs and rS waves, the R / S amplitude index 0.51 ± 0.38, the R wave duration index 0.55 ± 0.26, RⅢ / R Ⅱ 0.95 ± 0.23, QSaVL / QSaVR1.12 ± 0.39. The R / S amplitude index of V_1 or V_2 lead of PVCs that was successfully ablated by left coronary sinus was higher than that of right coronary sinus (P <0.05). Conclusions Successful ventricular arrhythmias succeeded by left coronary sinus ablation compared with right coronary sinus. The relevant features of the surface ECG help to determine the specific site of ablation of ventricular arrhythmias in the aortic sinus.