体表心电图在经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病中的作用

马志玲; 邵虹; 耶闯; 雷常慧; 刘丽文; 郭兰燕

doi:10.12125/j.chj.202002010

体表心电图在经皮心肌内室间隔射频消融术治疗梗阻性肥厚型心肌病中的作用

Body surface electrocardiogram in percutaneous myocardial chamber interval radiofrequency ablation in treatment of obstructive hypertrophic cardiomyopathy

摘要

摘要:
目的评价体表心电图在经皮心肌内室间隔射频消融（PIMSRA）术治疗梗阻性肥厚型心肌病(HOCM)中的作用。
方法纳入2017年4月至2018年11月在空军军医大学西京医院肥厚型心肌病诊治中心接受PIMSRA治疗的HOCM患者46例，对其心电图多参数进行回顾性分析。采用体表心电图评价术前和术后1周、1个月和3个月、6个月QRS波时限（aVF、V1），R+S波电压之和（aVF、V1、V2、V3），ST段抬高或下移（V1、V2、V3、V5），SV1+RV5电压之和，以及部分患者随访2年的心律失常事件的计数统计。
结果与术前比较，术后6个月V1、V2导联R波与S波电压之和较术前显著减低；术后1周V1、V2导联ST段较术前显著抬高。与术后1周比较，术后3个月、6个月V1、V2导联ST显著性回落。从术前、术后1周、术后1个月、术后3个月、术后6个月各ECG参数趋势图变化中发现，aVF导联、V1、V2导联R波与S波电压之和均呈下降趋势；V1、V2、V3导联ST段术后一周快速抬高后，呈渐进式下降。2例患者术后出现新的完全性右束支传导阻滞，4例患者术后1年，心律失常转为正常窦性心律，无1例患者术后出现新的完全性左束支传导阻滞。
结论 PIMSRA是一种安全、有效的治疗HOCM新技术，ECG在术前、术中、术后起到重要的指导和监测作用。

Abstract:
AIM To investigate the effect of surface electrocardiogram (ECG) in percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for patients with hypertrophic obstructive cardiomyopathy (HOCM).
METHODS Forty-six HOCM patients who were treated with PIMSRA between April 2017 to November 2018 in Hypertrophic Cardiomyopathy Center, Xijing Hospital of Air Force Medical University, were enrolled and their ECG parameters were analyzed retrospectively, which include the QRS width (AVF, V1); R + S wave voltage in leads AVF, V1, V2 and V3; ST segment elevation or depression in leads V1, V2, V3 and V5; Sv1+Rv5 voltage before the procedure, after 1 week, 1 month, 3 month, and 6 month respectively. Furthermore, arrhythmia events during a two-year follow-up were also evaluated by surface ECG.
RESULTS Compared with those ECG before the operation, the sum of R wave and S wave voltage in leads V1 and V2 decreased significantly in 6 months after the operation, and ST in leads V1 and V2 elevated significantly in 1 week after operation. Compared with those 1 week after operation, ST in leads V1 and V2 depressed significantly in 3 and 6 months. Two patients developed new complete right bundle branch block (RBBB) and 4 patients recovered to normal sinus rhythm one year after operation.
CONCLUSION PIMSRA is a safe and effective new technique for the treatment of obstructive hypertrophic cardiomyopathy. ECG plays an important guidance and monitoring role during perioperative period.

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