Yoshida Y, Hirai M, Murakami Y, Kondo T, Inden Y, Akahoshi M, Tsuda M, Okamoto M, Yamada T, Tsuboi N, Hirayama H, Ito T, Toyama J, Saito H
First Department of Internal Medicine, University of Nagoya School of Medicine, Japan.
Pacing Clin Electrophysiol. 1999 Dec;22(12):1760-8. doi: 10.1111/j.1540-8159.1999.tb00408.x.
Radiofrequency catheter ablation guided by pace-mapping techniques has proven effective in eliminating idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT). A method for rapidly identifying the origin of VT from 12-lead electrocardiogram (ECG) findings would be helpful for the catheter ablation procedure. The purpose of this study is to precisely localize the origin of idiopathic VT from the RVOT by a 12-lead ECG from a study of multipoint pace mapping. In one patient with premature ventricular complex (PVC) and 3 with VT, a "basket" catheter was deployed in the RVOT for bipolar pacing from 56 sites in the endocardium of RVOT. Under fluoroscopy the pacing sites were classified into the septum and free wall. We investigated the QRS morphology in leads, I, II, and III; the depth of the QS wave in leads aVR and aVL; and the height of the initial r wave in leads V1 and V2. Pacing was captured in 30-47 of 56 sites (54%-84%). As the pacing sites changed from the anterior to posterior of the septum, the QS notch (-) type in lead I shifted through rs to R, while a shift from R type to rR' or Rr' was noted in leads II and III. As the pacing sites changed from the anterior to posterior of the free wall, lead I showed a shift from the QS notch (+) type to R, while a shift from rR' to Rr' (or rR' unchanged) was found in leads II and III. The depth of the QS wave in leads aVR and aVL showed a tendency for aVR to be deeper than aVL toward the posterolateral attachment of both the septum and free wall, whereas aVL tended to be deeper than aVR toward the anterior attachment. The initial r waves in V1 and V2 became greater as the pacing site was positioned at a higher or more posterior location. These findings may provide more precise and clinically useful diagnostic information on the site of the origin of idiopathic VT originating from the RVOT by a 12-lead ECG.
经起搏标测技术引导的射频导管消融已被证明在消除起源于右心室流出道（RVOT）的特发性室性心动过速（VT）方面是有效的。一种从12导联心电图（ECG）结果快速识别VT起源的方法将有助于导管消融手术。本研究的目的是通过多点起搏标测研究，从12导联ECG精确确定RVOT特发性VT的起源。在1例室性早搏（PVC）患者和3例VT患者中，将一个“篮状”导管置于RVOT，用于从RVOT心内膜的56个部位进行双极起搏。在荧光透视下，起搏部位被分为间隔和游离壁。我们研究了I、II和III导联的QRS形态；aVR和aVL导联QS波的深度；以及V1和V2导联初始r波的高度。在56个部位中的30 - 47个部位（54% - 84%）捕获到了起搏。随着起搏部位从间隔的前部向后部改变，I导联的QS切迹（-）型通过rs转变为R，而在II和III导联中则注意到从R型转变为rR'或Rr'。随着起搏部位从游离壁的前部向后部改变，I导联显示从QS切迹（+）型转变为R，而在II和III导联中发现从rR'转变为Rr'（或rR'不变）。aVR和aVL导联中QS波的深度显示，在间隔和游离壁的后外侧附着处，aVR有比aVL更深的趋势，而在前附着处aVL往往比aVR更深。随着起搏部位位于更高或更靠后的位置，V1和V2导联中的初始r波变得更大。这些发现可能通过12导联ECG为起源于RVOT的特发性VT的起源部位提供更精确且临床上有用的诊断信息。
