CAJ | 학술논문

目的根据三维超声心动图精确定位的起搏心电图特点来评价起搏电极导线位于右心室流出道的位置.方法 40例植入永久性起搏器的患者,植入术中经二维X线影像定位示心室起搏电极导线位于右心室流出道高位间隔部,植入术后行心脏三维超声心动图检查以评价心室电极导线位于右心室流出道的精确位置,并分析起搏电极导线位于不同部位的体表起搏心电图特点.结果三维超声心动图示起搏电极导线位于高位间隔者23例(57.5%),低位间隔者6例(15.0%),游离壁者11例(27.5%).与游离壁相比,起搏电极导线位于高位间隔时,其下壁导联起搏心电图的R波振幅高[(1.28±0.18)mV vs(0.88±0.18)mV,P＜0.001]、QRS时限短[(132.5±8.3)ms vs(155.3±6.9)ms,P＜0.001]、顿挫少(21.7% vs 90.9%,P＜0.001),胸前导联R/S移行早(大于V4,24%vs 81%,P＜0.05);起搏电极导线位于低位间隔时,其R波振幅也较高[(1.43±0.13)mV vs(0.88±0.18)mV,P＜0.001]、时限也较短[(143.5±4.3)ms vs(155.3±6.9)ms,P=0.004],胸前导联R/S移行早(大于V4,24%vs 81%,P＜0.05).而高位间隔与低位间隔相比,高位间隔QRS波时限更短[(132.5±8.3)ms vs(143.5±4.3)瑚,P=0.003].另外,当起搏电极导线位于后间隔时,Ⅰ导联上的QRS波以正向波为主,位于前间隔时则以负向波为主.结论三维超声心动图有利于心室起搏电极导线在右心室流出道的精确定位;不同部位起搏的心电图具有不同的特点,这些特点有利于植入术中起搏电极导线在右心室流出道的定位,当起搏电极导线位于后间隔时,其起搏心电图Ⅰ导联为正向波,前间隔时为负向波.
목적 근거삼유초성심동도정학정위적기박심전도특점래평개기박전겁도선위우우심실류출도적위치.방법 40례식입영구성기박기적환자,식입술중경이유X선영상정위시심실기박전겁도선위우우심실류출도고위간격부,식입술후행심장삼유초성심동도검사이평개심실전겁도선위우우심실류출도적정학위치,병분석기박전겁도선위우불동부위적체표기박심전도특점.결과 삼유초성심동도시기박전겁도선위우고위간격자23례(57.5%),저위간격자6례(15.0%),유리벽자11례(27.5%).여유리벽상비,기박전겁도선위우고위간격시,기하벽도련기박심전도적R파진폭고[(1.28±0.18)mV vs(0.88±0.18)mV,P＜0.001]、QRS시한단[(132.5±8.3)ms vs(155.3±6.9)ms,P＜0.001]、돈좌소(21.7% vs 90.9%,P＜0.001),흉전도련R/S이행조(대우V4,24%vs 81%,P＜0.05);기박전겁도선위우저위간격시,기R파진폭야교고[(1.43±0.13)mV vs(0.88±0.18)mV,P＜0.001]、시한야교단[(143.5±4.3)ms vs(155.3±6.9)ms,P=0.004],흉전도련R/S이행조(대우V4,24%vs 81%,P＜0.05).이고위간격여저위간격상비,고위간격QRS파시한경단[(132.5±8.3)ms vs(143.5±4.3)호,P=0.003].령외,당기박전겁도선위우후간격시,Ⅰ도련상적QRS파이정향파위주,위우전간격시칙이부향파위주.결론 삼유초성심동도유리우심실기박전겁도선재우심실류출도적정학정위;불동부위기박적심전도구유불동적특점,저사특점유리우식입술중기박전겁도선재우심실류출도적정위,당기박전겁도선위우후간격시,기기박심전도Ⅰ도련위정향파,전간격시위부향파.
Objectives The present study was designed to explore the effects of pacing electrocardiogram under instruction of three dimensional echocardiogram in identifying the location of pacing electrodes in right ventricular outflow tract (RVOT). Methods In 40 patients with implanted permanent pacemakers, the electrode leads were planted in superior RVOT as far as possible, then three-dimensional echocardiograms were performed to identify the location of electrodes in RVOT precisely. Pacing electrocardiograms for free wall, superior and inferior septum of RVOT were analyzed. Results Pacing electrodes located in superior septum were founded in 23 patients, in inferior septum in 6 patients and in free wall in 11 patients. Compared with throe for free wall, the pacing electrocardiograms for superior septum were taUer[(1.28 ± 0.18 )mV vs (0.88 ± 0.18 )mV,P<0.001 ], narrower[(132.5±8.3)ms vs (155.3 ±6.9) ms,P <0.001] and lacked "notching" (21.7% vs 90.9% ,P <0.001 ) in inferior leads and earlier R/S transition in precordial leads( beyond V4, 24% vs 81% ,P<0.05). So did pacing electrocardiograms for inferior septum when compmed with those for free walL The narrower QRS waves were founded in superior septum compared with those in inferior septum. In addition, QRS waves of lead I were mainly positive when electrodes located in right posterior septum and mainly negative when located in left anterior septum. Condusiorm Three-dimensional echecardiograms can be used to locate the pacing electrodes precisely. Different sites of RVOT have different pacing electrocardiograms features which can help to identify the location of electrodes.