Tada Hiroshi, Tadokoro Kazuyoshi, Ito Sachiko, Naito Shigeto, Hashimoto Tohru, Kaseno Kenichi, Miyaji Kohei, Sugiyasu Aiko, Tsuchiya Taketsugu, Kutsumi Yasunori, Nogami Akihiko, Oshima Shigeru, Taniguchi Koichi
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
Heart Rhythm. 2007 Jan;4(1):7-16. doi: 10.1016/j.hrthm.2006.09.025. Epub 2006 Sep 28.
Idiopathic ventricular tachycardias (VTs) and premature ventricular contractions (PVCs) arising from the tricuspid annulus have been reported.
The purpose of this study was to clarify the prevalence and characteristics of VT/PVCs originating from the tricuspid annulus.
The ECG characteristics and results of radiofrequency (RF) catheter ablation were analyzed in 454 patients with idiopathic VT/PVCs.
Thirty-eight (8%) patients had VT/PVCs arising from the tricuspid annulus: 28 VT/PVCs (74%) originated from the septal portion of the tricuspid annulus and the remaining 10 (26%) from the free wall of the tricuspid annulus. QRS duration and Q-wave amplitude in each of leads V1-V3 were greater in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus (all P < .01). "Notching" of the QRS complex was observed more often in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus (P < .01). A Q wave in lead V1 was observed more often in VT/PVCs arising from the septum of the tricuspid annulus than those from the free wall of the tricuspid annulus (P < .005). R-wave transition occurred beyond lead V3 more often in VT/PVCs arising from the free wall of the tricuspid annulus than those from the septum of the tricuspid annulus (P < .005). RF catheter ablation eliminated 90% of the VT/PVCs arising from the free wall of the tricuspid annulus but only 57% of the VT/PVCs arising from septum of the tricuspid annulus.
Idiopathic VT/PVCs arising from tricuspid annulus are not rare, and the detailed origin can be determined by ECG analysis. The preferential site of origin was the septum but also could be the free wall of the tricuspid annulus.
已有报道称特发性室性心动过速（VT）和室性早搏（PVC）起源于三尖瓣环。
本研究旨在明确起源于三尖瓣环的室性心动过速/室性早搏的患病率及特征。
分析454例特发性室性心动过速/室性早搏患者的心电图特征及射频（RF）导管消融结果。
38例（8%）患者的室性心动过速/室性早搏起源于三尖瓣环：28例室性心动过速/室性早搏（74%）起源于三尖瓣环的间隔部分，其余10例（26%）起源于三尖瓣环的游离壁。起源于三尖瓣环游离壁的室性心动过速/室性早搏在V1 - V3导联的QRS波时限及Q波振幅均大于起源于三尖瓣环间隔的室性心动过速/室性早搏（均P < 0.01）。起源于三尖瓣环游离壁的室性心动过速/室性早搏比起源于三尖瓣环间隔的室性心动过速/室性早搏更常出现QRS波群“切迹”（P < 0.01）。起源于三尖瓣环间隔的室性心动过速/室性早搏比起源于三尖瓣环游离壁的室性心动过速/室性早搏更常出现V1导联Q波（P < 0.005）。起源于三尖瓣环游离壁的室性心动过速/室性早搏比起源于三尖瓣环间隔的室性心动过速/室性早搏更常出现R波移行超过V3导联（P < 0.005）。RF导管消融消除了90%起源于三尖瓣环游离壁的室性心动过速/室性早搏，但仅消除了57%起源于三尖瓣环间隔的室性心动过速/室性早搏。
起源于三尖瓣环的特发性室性心动过速/室性早搏并不罕见，通过心电图分析可确定其详细起源部位。优先起源部位是间隔，但也可能是三尖瓣环的游离壁。
