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目的 通过研究起源于主动脉左右冠状窦交界处室性早搏的心电图特征,探讨该部位射频消融治疗的有效性及安全性。方法 回顾性分析近2年来我院19例起源于左右冠状窦交界处室性早搏患者的体表心电图特征,研究不同的射频消融导管贴靠方式,评价手术疗效。结果 主动脉左右冠状窦交界处起源室性早搏体表心电图特点为:胸前导联移行较早(V
3
导联之前),V
1
导联常见降支有切迹的QS型或r S型,部分患者成功消融部位具有窦性心律晚电位,主动脉窦内瓣上瓣下无特异性差别。三维Catro 3标测进一步证实室性早搏最早起源位于两窦之间:瓣上12例、瓣下7例。瓣上消融采用导管J形贴靠于左右冠状窦之间,双向对侧反复消融,多数患者室性早搏即刻终止,但部分患者仍需行主动脉瓣下U形贴靠于两窦之间,心室侧消融方可取得效果,即刻手术成功率均可达100%。随访资料证实术后1、3、6及12个月均未复发。结论 起源于左右冠状窦交界处室性早搏的体表心电图可有特征性表现;瓣上瓣下导管联合消融可以明显提高手术安全性及成功率。
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