Josephson M E, Horowitz L N, Farshidi A, Spielman S R, Michelson E L, Greenspan A M
Circulation. 1979 Mar;59(3):459-68. doi: 10.1161/01.cir.59.3.459.
Two or more morphologically distinct ventricular tachycardias were observed during electrophysiologic study in 14 patients with chronic sustained ventricular tachycardia. Nine of these patients had clinical ventricular tachycardia with multiple morphologies. During the study 13 patients manifested both right bundle branch block (RBBB) and left bundle branch block (LBBB) morphologies. The remaining patient had RBBB with both right and left axis deviation. Changing morphologies were observed spontaneously in four patients and could be produced in all 14 by ventricular stimulation. In 12 patients both RBBB and LBBB originated in the left ventricle, and in 11 of these patients, from within a left ventricular aneurysm. Diastolic fragmented activity representing reentry was unchanged during both morphologies in four patients and during one morphology in five patients. Epicardial mapping confirmed the aneurysm as the site of origin of multiform ventricular tachycardias in two patients. Our data suggest that 1) ventricular tachycardia is frequently pleomorphic; 2) multiple morphologies usually represent variable exit sites and/or ventricular activation during the same tachycardia; and 3) there is a frequent association of pleomorphic ventricular tachycardia with left ventricle aneurysm.
在对14例慢性持续性室性心动过速患者进行电生理研究期间，观察到两种或更多形态学上不同的室性心动过速。其中9例患者的临床室性心动过速具有多种形态。研究期间，13例患者表现出右束支传导阻滞（RBBB）和左束支传导阻滞（LBBB）两种形态。其余1例患者表现为RBBB伴左右轴偏移。4例患者的室性心动过速形态自发改变，在所有14例患者中通过心室刺激均可诱发形态改变。12例患者的RBBB和LBBB均起源于左心室，其中11例起源于左心室室壁瘤内。4例患者在两种形态时以及5例患者在一种形态时，代表折返的舒张期碎裂电位均无变化。心外膜标测证实，2例患者的多形性室性心动过速起源于室壁瘤部位。我们的数据表明：1）室性心动过速常为多形性；2）多种形态通常代表同一心动过速期间不同的激动出口部位和/或心室激动；3）多形性室性心动过速常与左心室室壁瘤相关。
