上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

少见的起源于左右冠窦交界处室性早搏的心电图特点和导管消融治疗探讨

臧敏华1，周 磊1，马建伟2，王新华1，何 奔1   

  1. 1.上海交通大学 医学院附属仁济医院心内科, 上海 200127; 2.上海交通大学附属胸科医院心内科, 上海 200030
  • 出版日期:2013-07-28 发布日期:2013-08-22
  • 通讯作者: 王新华, 电子信箱: ttwwxh@126.com; 何奔, 电子信箱: heben@medmail.com.cn。
  • 作者简介:臧敏华（1976—），女，主治医师，硕士; 电子信箱: zangminhua@gmail.com。
  • 基金资助:

    国家临床重点专科项目(2012年度)

Electrocardiographic characteristics and catheter ablation of ventricular ectopic beats originating from junction of left and right coronary sinuses of Valsalva in aorta

ZANG Min-hua1, ZHOU Lei1, MA Jian-wei2, WANG Xin-hua1, HE Ben1   

  1. 1.Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China; 2.Department of Cardiology, Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2013-07-28 Published:2013-08-22
  • Supported by:

    National Key Clinical Discipline Project, 2012

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摘要：

目的 探讨左右冠窦交界处起源室性期前收缩（室性早搏）的心电图特点及其导管消融治疗。方法 应用三维标测系统对两例左心室流出道室性早搏患者进行心内电生理检查和导管消融。结果 电生理检查示两例室性早搏均起源于左右冠窦交界处。体表心电图特点为胸前导联移行较早（V3导联之前），V1导联为降支带切迹的QS型、V1-V3导联之一呈qrS型，或无特征性形态。导管贴靠于左右冠窦之间，或贴靠于两窦交界的左冠窦侧，两例室性早搏均获得完全消除。结论 起源于左右冠窦交界处室性早搏的体表心电图有特征性表现，也可无特征性形态;采用适当的导管贴靠方法可以成功消融。

关键词: 室性期前收缩, 乏氏窦, 导管消融, 心电图

Abstract:

Objective To explore the electrocardiographic characteristics and catheter ablation of ventricular ectopic beats originating from the junction of left and right coronary sinuses of Valsalva in the aorta. Methods Electrocardiographic examination and ablation were performed under the guidance of three dimensional mapping systems in two patients with ectopic beats originating from left ventricular outflow tract. Results Ectopic beats were mapped to originate from the junction of left and right coronary sinuses of Valsalva in both patients. The electrocardiograms showed early precordial transition of QRS complex prior to lead V3 in two patients, the notching QS morphology in lead V1, the qrS pattern in leads V1-V3 in one patient and non-specific morphology in the other patient. Subsequent ablation by positioning the irrigated catheter at the junction of two sinuses of Valsalva or at the left side of the junction (in left coronary sinus of Valsalva) successfully abolished ectopic beats in two patients. Conclusion There may be or may not be characteristic electrocardiographic findings for ventricular ectopic beats originating from the junction of left and right coronary sinuses of Valsalva in the aorta, and catheter ablation could abolish them successfully by proper catheter placement.

Key words: ventricular ectopic beat, sinus of Valsalva, catheter ablation, electrocardiogram