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目的探讨心电图Ⅰ导联QRS波形态呈m型在流出道室性心律失常(PVC)中的定位诊断价值。方法回顾性分析成功行射频消融的流出道PVC患者357例,根据消融成功的心腔分为两组:左室流出道(LVOT)消融成功者(A组,n=139),右室流出道(RVOT)消融成功者(B组,n=218),比较两组患者心电图Ⅰ导联QRS波呈m型的例数、Ⅰ导联QRS波的振幅、靶点位置及靶点图电位特点。结果 (1)A组患者9例Ⅰ导联QRS波形态呈m型,B组患者30例Ⅰ导联QRS波形态呈m型,发生率有显著差异(6.5%vs 13.8%,P<0.05)。(2)两组患者Ⅰ导联QRS波振幅有显著差异[(0.38±0.13)mV vs(0.21±0.13)mV,P<0.01];两组患者Ⅰ导联QRS波时程差异无显著性[(129.0±29.4)ms vs(145.6±26.0)ms,P>0.05]。(3)A组消融成功靶点位置位于RCC前部,B组消融成功靶点位置位于RVOT左侧肺动脉瓣附近游离壁、间隔交界处的间隔侧,两者靶点解剖位置相距较近。(4)两组靶点图V波提前QRS波程度有显著差异[(31±12.3)ms vs(21±5.7)ms,P<0.05]。结论流出道PVC的Ⅰ导联QRS波形态呈m型提示消融成功靶点位置在RCC前部,或RVOT左侧肺动脉瓣附近游离壁、间隔交界处的间隔侧,RVOT起源多于LVOT起源,且两者靶点解剖位置相距较近。
Objective To investigate the diagnostic value of QRS waveform of lead Ⅰ in electrocardiogram (ECG) in the location of m-type in ventricular arrhythmia (PVC). Methods A retrospective analysis of 357 cases of PVC patients who underwent radiofrequency catheter ablation was performed and divided into two groups based on the successful ablation of the left ventricle: left ventricular outflow tract (LVOT) successful ablation (group A, n = 139), right ventricular outflow tract (Group B, n = 218). The frequency of QRS wave was m-type in ECG Ⅰ-lead, the amplitude of QRS wave in leadⅠ, the location of target and the potential of target plot were compared between the two groups. Results (1) The QRS waveform of lead Ⅰ in group Ⅰ was m-type in group A, and the QRS waveform in lead Ⅰ in group B was m-type in group B (6.5% vs 13.8%, P <0.05) . (2) There was a significant difference in QRS amplitude of lead Ⅰ between the two groups [(0.38 ± 0.13) mV vs (0.21 ± 0.13) mV, P <0.01] (129.0 ± 29.4) ms vs (145.6 ± 26.0) ms, P> 0.05]. (3) The successful target location of ablation in group A is located in the anterior part of RCC, and the successful target location of ablation in group B is located at the free wall near the left pulmonary valve of RVOT and the interval side of the interval junction. (4) There was a significant difference in the QRS wave amplitude between the two groups before V wave [(31 ± 12.3) ms vs (21 ± 5.7) ms, P <0.05]. CONCLUSIONS: The QRS waveform of lead Ⅰ in the outflow tract is presented in m-shape. The successful site of the ablation is at the anterior part of the RCC or the free wall near the RVOT on the left side of the RVOT. The origin of the RVOT is more than the origin of the LVOT The two target anatomical location closer.