9例希氏束左侧起源室早特点及消融疗效分析

Analysis of characteristics and ablation of premature ventricular contractions originating from left His bundle in 9 cases

关键词:  希氏束  室性早搏  射频消融  电解剖标测

Key words:  His bundle  ventricular premature  catheter ablation  electroanatomical mapping

摘要:

目的　研究起源于希氏束左侧的频发室性早搏（室早）的心电图特点并观察电解剖标测（Carto）指导下射频消融效果。方法　选取大连医科大学附属第一医院自2010年1月至2018年6月经心内电生理检查诊断为起源于希氏束左侧的频发室早患者9例，在Carto指导下进行标测及导管射频消融，分析其体表心电图特征、心内电图及消融结果。结果　起源于左侧希氏束旁的室早心电图表现为：（1）胸前导联QRS波群时限较短；（2）胸前导联移行区通常在V1-V2导联之间；（3）以R波为主波的导联顶端尖锐无切迹、顿挫；（4）V1导联通常呈rS或者R型。9例中4例患者行射频消融术，成功率100%。结论　希氏束左侧起源的室早具有特定的心电图特点，在Carto三维标测指导下可以成功进行射频消融。

Abstract:

Objective　To study the electrocardiogram (ECG) characteristics of frequent premature ventricular contractions originating from left His bundle and the radiofrequency ablation effects under the guidance of electroanatomical mapping (Carto).　Methods　From 2010 to 2017, 9 patients with frequent premature ventricular contractions originating from the left His bundle in our hospital were selected for mapping and radiofrequency catheter ablation under the guidance of carto. Their ECG characteristics and ablation results were analyzed. 　Results　The ECG of premature ventricular contractions originating from the left His bundle showed: (1) the duration of QRS complex in the precordial lead was shorter.(2) the transition zone of the thoracic lead was usually before lead V2 or lead V2. (3) the lead with R wave as the main wave was sharp without notch or cadence at the top. (4) V1 lead was usually rS or R type. Four patients underwent radiofrequency ablation with a success rate of 100%. 　Conclusion　The premature ventricular contractions originating from the left His bundle have some ECG characteristics, and radiofrequency ablation could be successfully performed under the guidance of carto 3-D mapping.