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目的 探讨心室颤动(室颤)初始心搏与室性早搏(室早)或室性心动过速(室速)是否同源,为消融室颤提供基础数据。方法 选择室颤高危患者记录动态心电图,比较室颤初始心搏与室早或室速各导联QTS形态的一致性,形态一致者起源点相同,作初步定位。结果 96例患者中,28例检出60例次室颤,55例次发作初始的3～53个心搏为有序的快速室速或扑动样节律,平均周长(185±36.4)ms。12例次自行终止,持续1.2-21.6(6±8.4)s;40例次电击终止;8例未终止死亡。1例次初先室颤,中转为室速,后又转为室颤。室颤自行终止与非自行终止者相比,初始节律的周长差异无显著性[(202±42.6)ms与(182±38.6)ms,P=0.066]。50例次室颤可见与其初始QRS形态一致的单发、成对室早或室速。48例次初始心搏为R-on-T。42例次初始QRS无伪差干扰,起源点呈聚集而非随机分布,18例次对应于右室前乳头肌区,6例次对应于右室流出道,11例次对应于左室前乳头肌区,7例次对应于左室后乳头肌区。9例多次室颤,7例有2-5种QRS形态。22例可见与室颤初始QRS态不同、未触发室颤的室早或室速。结论 室颤与某些室早或室速同源,起源点聚集分布,好发于乳头肌周围,以室早或室速起源为消融靶点有望消除室颤。自行终止的短阵室颤并不少见,及时识别有着生命攸关的临床意义。
Objective To investigate whether initial ventricular fibrillation (VF) is homologous to premature ventricular contractions (ventricular premature ventricular tachycardia) or ventricular tachycardia (ventricular tachycardia) and provide basic data for the treatment of ventricular fibrillation. Methods Patients with high risk of ventricular fibrillation were recorded dynamic electrocardiogram, ventricular fibrillation compared with the initial ventricular rate or ventricular tachycardia QTS morphology of the consistency, the same origin of morphological consistent, for initial positioning. Results Among the 96 patients, 28 cases were found to have ventricular fibrillation (VFV), and 55 cases with initial onset of 3 ~ 53 beats were ordered VTs or flutter-like rhythms with an average circumference of 185 ± 36.4 ms . 12 cases ended spontaneously, lasting 1.2-21.6 (6 ± 8.4) s; 40 cases were terminated by electric shock; 8 cases did not terminate the death. One case of initial ventricular fibrillation, the transfer to ventricular tachycardia, and later converted to ventricular fibrillation. There was no significant difference in the circumference of the initial rhythm between patients with and without self-terminator VF [(202 ± 42.6) ms and (182 ± 38.6) ms, P = 0.066]. 50 cases of ventricular fibrillation can be seen with its initial QRS morphology consistent with single, twin or ventricular rate. 48 cases of initial heart rate R-on-T. 42 cases of initial QRS no artifact interference, the origin of the site was gathered rather than randomly distributed, 18 cases corresponding to the right ventricular anterior papillary muscle area, 6 cases corresponding to the right ventricular outflow tract, 11 cases corresponding to the left ventricular anterior nipple Muscle region, 7 cases correspond to the left ventricular papillary muscle area. 9 cases of multiple ventricular fibrillation, 7 cases of 2-5 QRS morphology. Twenty-two patients were found to be different from the initial QRS status of ventricular fibrillation, and ventricular tachycardia or ventricular tachycardia was not triggered. Conclusions Ventricular fibrillation is homologous to some ventricular premature or ventricular tachycardia. The origin of the ventricular fibrillation is distributed and distributed in the papillary muscles. It is expected that ventricular fibrillation will be eliminated by using ventricular premature ventricular or ventricular tachycardia as the target of ablation. Self-terminating episodes of ventricular fibrillation are not uncommon and timely identification has a life-critical clinical implications.