右束分支阻塞室内心动脉冲动:隔膜与侧腔室的起源基于激活时间到右室内顶部
Vickas V Patel1, Robert W Rho, Edward P Gerstenfeld
1Section of Cardiac Electrophysiology, University of Pennsylvania Health System, Philadelphia, Pa, USA.
Circulation
|October 20, 2004
概括
区分心室低心率 (VT) 的起源是具有挑战性的. 这项研究表明,QRS-RVA时间有效地将隔膜与侧面起源区分开来,特别是在心脏病发作后.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗成像医学成像
背景情况:
- 使用标准的12导电心电图,很难确定心室低心率 (VT) 的起源,右束分支块 (RBBB) 类型的模式和领先V1的RS比率>1是很困难的.
- 先前的顶心梗塞进一步复杂化了源自隔膜与左心室侧壁相对应的VT基于心电图的定位.
研究的目的:
- 评估QRS复合体发作到右心室顶部激活 (QRS-RVA) 时间在区分隔膜与侧心室动脉动脉 (VT) 起源方面的实用性.
- 评估这种方法在患有或没有先前心梗塞的患者中的有效性.
主要方法:
- 对58名静脉瘤患者的前性评估,根据心脏病发作,非心脏病发作或没有心脏病进行分类.
- 测量QRS复合体在左心室 (LV) 顶部隔膜和侧面节奏期间在右心室顶部 (stim-RVA) 激活.
- 47个RBBB型VTs的定位到隔膜或侧面顶部使用引进技术并通过电解剖绘图进行确认.
主要成果:
- 在所有患者群体中,在隔膜和侧面节奏/静脉位之间观察到刺激-RVA和QRS-RVA时间的显著差异.
- 在患有角膜心脏病的患者中,刺激-RVA为59毫秒 (第七位) 与187毫秒 (侧面),QRS-RVA为50毫秒 (第七位) 与178毫秒 (侧面) (P<0.001).
- 同样的显著差异在患有非神经动脉梗塞和没有心脏病的患者中也被发现,这证实了区域特异性.
结论:
- QRS-RVA时间在从左心室隔膜和侧顶开始的VT之间显著不同.
- 这些发现为快速区域化RBBB型VTs的VT来源提供了有价值的工具,V1 R-S比率>1.1.
- 这种方法特别适用于心梗塞患者,因为传统的心电图分化不那么可靠.
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