作者：李文华，肖建强，徐波

单位：

213002 江苏省常州市武进人民医院心内科；通信作者：李文华，E-mail：64641233@qq.com

Units：

Department of Cardiology，Changzhou Wujin People's Hospital，Changzhou 213002，China；Corresponding author：LI Wenhua，E-mail：64641233@qq.com

关键词：

心律失常，心性；特发性室性心律失常；心电描记术；导管消融术，射频；疾病特征；治疗结果

Keywords：

Arrhythmias，cardiac；Idiopathic ventricular arrhythmias；Electrocardiography；Catheter ablation，radiofrequency；Disease attributes；Treatment outcome

CLC：

R 541.7

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.012

Funds：

摘要：

目的　分析 131 例特发性室性心律失常（IVAs）患者起源分布、心电图特征及射频导管消融（RFCA）术效果，为提高临床 IVAs 诊治水平提供参考。方法　选取 2009 年 1 月—2018 年 10 月在常州市武进人民医院心内科行RFCA术的IVAs患者131例，采用体表标准十二导联心电图分析其起源分布及不同起源部位患者心电图特征；比较左、右心室流出道起源的IVAs患者QRS波时限、下壁导联（Ⅱ、Ⅲ、aVF导联）R波振幅及Ⅰ、aVL、aVR导联QRS波振幅，并比较行 X 线指导下与三维电解剖标测系统（Carto3）指导下 RFCA 术者 RFCA 术情况。结果　（1）131 例 IVAs 患者起源部位为右心室者 91 例（占 69.47%），左心室者 33 例（占 25.19%），心外膜者 1 例（占 0.76%），不确定者 6例（占 4.58%）。（2）131 例 IVAs 患者中起源部位为左心室流出道者 19 例（占 14.50%），右心室流出道者 77 例（占58.78%）。起源部位为左心室流出道者 QRS 波时限长于起源部位为右心室流出道者，下壁导联（Ⅱ、Ⅲ、aVF 导联）R 波振幅高于起源部位为右心室流出道者，aVL、aVR 导联负向 QRS 波深于起源部位为右心室流出道者（P<0.05）；左、右心室流出道起源的 IVAs 患者Ⅰ导联 QRS 波振幅比较，差异无统计学意义（P>0.05）。（3）131 例 IVAs 患者中行X 线指导下 RFCA 术者 77 例，行 Carto3 指导下 RFCA 术者 54 例。行 X 线指导下与 Carto3 指导下 RFCA 术者 IVAs 类型、RFCA 术成功率、手术时间、放电时间、成功消融部位 V 波领先 QRS 波起点时间及术后左心室舒张末期内径、左心房内径、左心室射血分数比较，差异无统计学意义（P>0.05）；行 X 线指导下 RFCA 术者 24 h 动态心电图记录的室性期前收缩次数少于行 Carto3 指导下 RFCA 术者，联合起搏标测者所占比例、放电功率及 X 线暴露剂量高于行 Carto3 指导下 RFCA 术者，有效消融时间长于行 Carto3 指导下 RFCA 术者（P<0.05）。结论　IVAs 患者起源部位以右心室居多，不同起源部位尤其是左、右心室流出道起源的 IVAs 患者心电图表现存在一定差异，体表标准十二导联心电图有助于快速定位 IVAs 患者起源部位；X 线指导下与 Carto3 指导下 RFCA 术成功率均较高，但与 X 线指导下 RFCA 术相比，Carto3 指导下 RFCA 术有利于减少 IVAs 患者起搏标测，降低放电功率及 X 线暴露剂量，缩短有效消融时间等。

Abstract：

Objective　To analyze the origin distribution，characteristics of electrocardiogram and effect ofradiofrequency catheter ablation（RFCA）in 131 patients with idiopathic ventricular arrhythmias（IVAs）. Methods　FromJanuary 2009 to October 2018，a total of 131 patients with IVAs were selected in the Department of Cardiology，ChangzhouWujin People's Hospital，body surface standard 12-lead electrocardiogram was used to analyze the origin distribution andcharacteristics of electrocardiogram in patients with different origins；QRS-wave duration，R-wave amplitude in inferior wallleads（including Ⅱ -，Ⅲ - and aVF-lead），as well as QRS-wave amplitude in Ⅰ -，aVL- and aVR-lead were comparedbetween left and right ventricular outflow tract originated patients，meanwhile RFCA related indicators was compared betweenpatients underwent X-ray and Carto3 guided RFCA. Results　（1）Of the 131 patients with IVAs，91 cases originatedfrom right ventricle（accounting for 69.47%），33 cases originated from left ventricle（accounting for 25.19%），1 caseoriginated from epicardium（accounting for 0.76%），but the other 6 cases'origins were not decided（accounting for 4.58%）.（2）Of the 131 patients with IVAs，19 cases originated from left ventricular outflow tract（accounting for 14.50%），77cases originated from right ventricular outflow tract（accounting for 58.78%）. Compared to that in right ventricular outflowtract originated patients，QRS-wave duration was statistically significantly longer in left ventricular outflow tract originatedpatients，R-wave amplitude in inferior wall leads（including Ⅱ -，Ⅲ - and aVF-lead）was statistically significantly higher，respectively，while negative QRS-wave was statistically significantly deeper in aVL- and aVR-lead，respectively（P<0.05）；no statistically significant difference of QRS-wave amplitude in Ⅰ -lead was found between left and right ventricular outflow tractoriginated patients（P>0.05）.（3）Of the 131 patients with IVAs，77 cases underwent X-ray guided RFCA and the other 54cases underwent Carto3 guided RFCA. There was no statistically significant difference of types of IVAs，success rate of RFCA，duration of operation，discharge time，leading time of V-wave in successfully ablated site to QRS-wave starting point，orpostoperative LVEDD，LAD or LVEF between patients underwent X-ray and Carto3 guided RFCA（P>0.05）；compared tothat in patients underwent Carto3 guided RFCA，attack frequency of PVC recorded by 24-hour dynamic electrocardiogram wasstatistically significantly less in patients underwent X-ray guided RFCA，proportion of patients adopted with pace mapping，discharge power and X-ray exposure dose were statistically significantly higher，and effective ablation time was statisticallysignificantly longer（P<0.05）. Conclusion　Most of patients with IVAs originated from right ventricle，and there is somedifference in electrocardiogram performance in IVAs patients with different origins，especially between left and right ventricularoutflow tract originated patients，however body surface standard 12-lead electrocardiogram is helpful to the quick positioning oforigins；both X-ray and Carto3 guided RFCA have relatively high success rate，but compared to that of X-ray guided RFCA，Carto3 guided RFCA is helpful to reduce the use of pace mapping，discharge power and X-ray exposure dose，as well as shortenthe effective ablation time.

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