背景:由左心室顶点(summit-CV)的交通静脉的不同部分引起的特发性室性心律失常(IVA)并不罕见。而其心电图(ECG)和电生理特征尚未得到充分研究。
目的:本研究旨在确定源自峰顶CV不同部分的IVA的不同心电图和电生理特征。
方法:本研究纳入19例确诊为Summit-CV的患者。
结果:19例患者根据其在峰顶CV中的目标部位分为近端和远端组。在近端部分组中,100%(11/11)VAs在I导联中显示显性负波(rs或QS),而在远端部分组中,87.5%(7/8)显示优势正波(R,Rs或r)(p<0.000)。在V1导联中,近端部分组的100%(11/11)显示显性正波(R或Rs),而远端组的62.50%(5/8)显示正负双向波或负波(RS或rS)(p<0.005)。RI>4mV,SI<3.5mV,RV1<13mV,SV1>3.5mV,RI/SI>0.83,RV1/SV1<2.6表示峰顶-CV的远端部分,预测值分别为0.909、1.000、0.653、0.972、0.903、0.966。I导联中的正波较大,V1导联中的负波较大,表明峰顶CV的远端起源较多。在标测过程中,近端和远端峰顶CV组中的目标部位显示出相似的电生理特征。
结论:在峰顶-CV的不同部分,VAs的ECG特征存在显着差异,这可以帮助术前计划并促进射频导管消融(RFCA)程序。
BACKGROUND: Idiopathic ventricular arrhythmias (IVAs) arising from different portions of the communicating vein of the left ventricular summit (summit-CV) are not a rare phenomenon. Whereas its electrocardiographic (ECG) and electrophysiological characteristics are not fully investigated.
OBJECTIVE: This study aimed to identify distinct ECG and electrophysiological features of IVAs originating from different portions of summit-CV.
METHODS: Nineteen patients confirmed arising from summit-CV were included in this study.
RESULTS: The 19 patients were divided into proximal and distal portion groups based on their target sites in summit-CV. In the proximal portion group, 100% (11/11) VAs showed dominant negative (rs or QS) waves in lead I, while in the distal portion group, 87.5% (7/8) showed dominant positive waves (R, Rs or r) (p < 0.000). In lead V1, 100% (11/11) of the proximal portion group showed dominant positive waves (R or Rs), while 62.50% (5/8) of the distal portion group showed positive and negative bidirectional or negative waves (RS or rS) (p < 0.005). RI>4mV, SI<3.5mV, RV1<13mV, SV1>3.5mV, RI/SI>0.83, and RV1/SV1< 2.6 indicated a distal portion of summit-CV with the predictive value of 0.909, 1.000, 0.653, 0.972, 0.903, 0.966, respectively. A more positive wave in lead I and a more negative wave in lead V1 indicated more distal origin in summit-CV. Target sites in proximal and distal summit-CV groups showed similar electrophysiological characteristics during mapping.
CONCLUSIONS: There were significant differences in ECG characteristics of VAs at different portions of summit-CV, which could aid pre-procedure planning and facilitate radiofrequency catheter ablation (RFCA) procedures.