左后分支特发室速的心电图特征及消融

                                                                                  2012-07-26

 

       8例患者术前均以体表心电图定位起源于左后分支处区域，其PVC或左心室室速的体表心电图均为典型特发性左心室室速(ILVT)表现(QRS波呈右束支阻滞图形，心电轴左偏，QRS时限≤160 ms)。其中，QRS波I导联6例呈rS，2例呈Rs；aVL导联呈qR；II、Ⅲ、aVF导联呈rS。胸前导联多在V1-V3处移形，由R转为Rs或rS。在消融成功部位(最早激动点)消融导管均记录到融合有浦肯野电位(PP)的V波，V波提前于体表心电图QRS波时限20-48(33.0±10.2)ms，8例患者行射频消融即时成功。

Eight patients were diagnosed as PVC originating form left posterior fascicular by ECG，and 5 patients were confirmed with 3-dimensional electroanatomic mapping．Most of the PVCs showed a RBBB morphology and left axis deviation，QRS duration≤160 Ins．In leadⅠ, 6 patients showed rS, and 2 patients showed Rs；qR in lead aVL，rS in lead II、Ⅲ、aVF．The early preeordial transition Was common at V1～V3 R into RS or rS．The earliest site of ventricular activation was recorded with PP and successful ablation．

Figure 1 Carto系统激动顺序图及三维电解剖图

（RAO）起源于左后分支的PVC激动顺序A至C，成功消融靶点位于左后分支。蓝色部分为未除极或已除极区域，红色部分为正在除极区域，红色标志点为靶点消融部位。D为三维电解剖标测图，在成功消融靶点处记录到心室最早激动点，并伴有蒲肯野纤维电位，红色标记为心室最早激动部位。

Figure 2  八例患者PVC的心电图特点

 

Figure 3   EGM during Mapping