导联轴 I 中正向 QRS 波群作为右室流出道心动过速的恶性标志：多形性和单形性室性心动过速的比较。
Positive QRS complex in lead i as a malignant sign in right ventricular outflow tract tachycardia: comparison between polymorphic and monomorphic ventricular tachycardia.
机构信息
Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan.
出版信息
Circ J. 2013;77(4):968-74. doi: 10.1253/circj.cj-12-0864. Epub 2012 Dec 14.
BACKGROUND
Idiopathic ventricular fibrillation (VF) or polymorphic ventricular tachycardia (PVT) arising from the right ventricular outflow tract (RVOT) is occasionally observed. The difference in the initial ventricular premature contraction (VPC) between VF/PVT and monomorphic VT (MVT) from the RVOT, however, has not yet been fully investigated.
METHODS AND RESULTS
The electrocardiogram findings and the clinical characteristics were compared between 14 patients with PVT and 77 with MVT. The episodes of syncope were more frequent in the VF and/or PVT group (57%) than in the MVT group (10%). An initial VPC with a positive QRS complex in lead I was observed in 10 (71%) of 14 patients with VF/PVT, and in 27 (35%) of 77 patients with MVT (P<0.05). Although radiofrequency (RF) catheter ablation targeting the trigger VPC often produced a morphological change, VF/PVT was eliminated in 13 (93%) of 14 patients after additional RF applications.
CONCLUSIONS
Malignant arrhythmias from the RVOT, although rare, should be considered when the patient has a syncopal episode and VPC with a positive QRS complex in lead I.
背景
特发性室颤（VF）或源于右心室流出道（RVOT）的多形性室性心动过速（PVT）偶尔会观察到。然而，VF/PVT 和源于 RVOT 的单形性室性心动过速（MVT）之间初始室性期前收缩（VPC）的差异尚未得到充分研究。
方法和结果
比较了 14 例 PVT 患者和 77 例 MVT 患者的心电图表现和临床特征。VF 和/或 PVT 组（57%）的晕厥发作比 MVT 组（10%）更频繁。VF/PVT 组的 14 例患者中有 10 例（71%），MVT 组的 77 例患者中有 27 例（35%）在 I 导联中观察到初始正向 QRS 复合波的 VPC（P<0.05）。尽管针对触发 VPC 的射频（RF）导管消融通常会产生形态学改变，但在 14 例患者中的 13 例（93%）中，在进行额外的 RF 应用后消除了 VF/PVT。
结论
当患者出现晕厥发作和 I 导联中正向 QRS 复合波的 VPC 时，虽然罕见，但应考虑 RVOT 的恶性心律失常。
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