摘要目的 探讨完全性左/右束支传导阻滞(CL/RBBB)合并流出道室性早搏(PVC)心电图和消融靶点图特征,并比较与无CL/RBBB流出道PVC的差别.方法 回顾性分析2009年8月至2017年6月成功行射频消融的8例CL/RBBB合并流出道PVC患者,根据束支传导阻滞形态分为两组:完全性右束支传导阻滞(CRBBB)组(4例);完全性左束支传导阻滞(CLBBB)组(4例),同时每例患者匹配在同一部位消融成功且无CL/RBBB的患者作为对照,比较CRBBB组、CLBBB组及对照组心电图、消融靶点图特征和射频消融治疗结果.结果 除CRBBB组1例患者于心大静脉消融成功者PVC时胸前导联R/S>1移行在V1导联和CLBBB组1例患者于右冠状动脉窦消融成功者胸前导联R/S>1移行在V2导联外,其他6例患者PVC时胸前导联R/S>1移行均在V4导联;CLBBB组患者PVC时胸前导联R/S>1移行均比窦性心律时QRS波早.CL/RBBB患者窦性心律和PVC的QRS波时限比较差别无统计学意义[(134.38±23.80)ms比(156.75±25.93)ms,P>0.05];对照组窦性心律和PVC时的QRS波时限比较差异有统计学意义[(92.63±5.76)ms比(140.25±15.97)ms,P<0.01].结论 合并CL/RBBB时,束支传导阻滞会干扰PVC起源心腔的判断,需根据术中标测和消融结果最终确定PVC的起源心腔.

abstractsObjective To explore the characteristics of electrocardiogram(ECG) and target potential features of premature ventricular contraction (PVC) in patients with complete left/right bundle branch block (CL/RBBB) and compare with those without CL/RBBB. Methods A retrospective analysis was done in 8 outflow tract PVC patients with CL/RBBB, who successfully underwent radiofrequency ablation from August 2009 to June 2017. According to the bundle branch block chamber, patients were divided into the complete right bundle branch block (CRBBB) group (n=4) and the complete left bundle branch block (CLBBB) group (n=4). The control group were those who successfully underwent ablation at the same position as the above two groups but without CL/RBBB. The characteristics of ECG and target potential features were compared among groups. Results One case in the CRBBB group was successfully ablated in the great cardiac vein with precordial R/S>1 transition at V1 and one case in the CLBBB group was successfully ablated in the right coronary cusp with precordial R/S>1 transition at V2, while other 6 cases were all with precordial R/S>1 transition at lead V4. Precordial R/S>1 transition was not later than sinus rhythm (SR) in the CLBBB group. No statistical difference was found in the QRS complex duration between SR and PVC in the CL/RBBB patients [(134.38 ± 23.80)ms vs (156.75 ± 25.93)ms, P>0.05], while statistical difference was shown in the control group [ (92.63 ± 5.76)ms vs (140.25 ± 15.97)ms,P<0.05]. Conclusion Bundle branch block can lead to misjudgment of PVC origin with CL/RBBB during sinus rhythm, thus the origin chamber of the PVC should be determined according to the mapping and ablation result.