Clinical And Electrophysiological Characteristics Of Non-outflow Tract Idiopathic Ventricular Arrhythmias In Patients Undertaken Catheter Ablation

Objective 1.To analyze and summarize the general clinical and electrophysiological characteristics of non-outflow tract idiopathic ventricular arrhythmias in patients undertaken catheter ablation in our hospital for 7 years,E.g: gender,age of onset,disease composition,preoperative antiarrhythmic drug use history,ejection fraction(EF),Left ventricular end-diastolic diameter and major predilection sites for left and right ventricular origin of non-outflow tract.2.Taking Carto3 D mapping results as a reference,systematically investigate ECG features of the above patients with ECG.Methods 1.Total of patients with premature ventricular contractions(PVCs)and(or)ventricular tachycardia(VT)and undertaken radiofrequency catheter ablation were studied from January 2012 to June 2018 in Department of Cardiology,Ningxia Medical University.12 leads ECGs were record when PVCs/VT occurred to all patients.2.The general clinical characteristics of all patients were analyzed,E.g: gender,age of onset,comorbidity,history of preoperative antiarrhythmic drug use,EF value,left ventricular end-diastolic diameter,and major predilection sites for left and right ventricular origin of non-outflow tract.3.Through retrospective analysis,combined with Carto3 D mapping and radiofrequency catheter ablation,the origin of ventricular arrhythmias was located.and the 12-lead ECG characteristics of each various origins were analyzed.such as morphology of ECGs of PVCs/VT,migration lead of R wave on chest leads and the migration index of R wave onchest leads were observed.Results 1.General clinical features: 33 patients with ventricular arrhythmias accepted radiofrequency catheter ablation successfully,including 22 males(66.67%),aged 43 years(31,56),7 patients with hypertension(21.21%),5 patients with diabetes(15.15%),preoperative use antiarrhythmic drugs in 26 cases(78.79%),left ventricular end-diastolic diameter 48mm(46.00 mm,52.50mm),EF value 67.39%(62.95%,70.75%).2.Various origins in the 33 cases of IVAs,15 cases originated from the left posterior branch.6 cases of atrioventricular annulus origin.4 cases were origin of left ventricular papillary muscle.There were 2 cases of the His bundle and the great cardiac vein.The remaining origins are all 1 case.3.Radiofrequency catheter ablation results: 31 of 33 patients had successful ablation,and the immediate success rate was 93.94%.4.ECG characteristics of non-outflow tract idiopathic ventricular arrhythmias(1)PVCs/VT in the left ventricle non-outflow flow tract are mostly rsR’ or R type(82.14%)in the V1 lead,ie right bundle branch conduction The Block Bundle Branch Block(RBBB)pattern;the R-wave shift of the chest lead was mostly before the V1 lead(85.71%),and the chest lead transition index was often <0(92.86%).among them:(1)The main wave of the inferior wall of the left posterior branch and the left posterior papillary muscle originated as rS/QS type,and most of the leads of I and aVL showed qR type and V5-6 lead showed rS/RS type.(2)The main wave of the inferior wall of the anterior wall of the mitral annulus is high R-shaped,and the V5-6 lead is Rs-type.(3)The most distant origin of the great cardiac veins,I and aVL leads were all rS/QS type,and the main wave of the inferior wall lead and V5-6 lead showed R type.(4)The origin of the left ventricle and the interventricular septum was 1 in each case.The main wave of the inferior wall lead and the V5-6 lead were upward,and all of them were R-type.The leads of I and aVL were all rS/QS type,and the V1 lead was rS type.(5)1 case of left ventricular septum,I,aVL and inferior leads are rS type,V1 lead isR/rsR’ type,V5-6 lead is RS type.(6)The origin of the left ventricular apex combined with the base segment was 1 case,the inferior leads and the V5-6 lead were QS type,of which I and aVL lead were rs type,and V1 lead was R type.(2)The PVCs/VT originating from the right ventricular non-outflow tract showed Rs/QS type(100%)in the Vl lead,and the chest lead R wave migrated more after the V3 lead(80.00%).The chest lead transition index was often > 0 is the majority(80.00%).The QRS wave patterns of the II、III、aVF leads of the tricuspid annulus,the posterior wall,and the origin of the His bundle are rS/QS,the main wave is dominated by negative waves,and the V5-6 lead is dominant R type.Conclusion 1.Patients with non-outflow tract PVCs/VT have normal cardiac function and no cardiovascular risk factors.2.Non-outflow tract IVAs occur in the left ventricle,with the left posterior branch being the main,followed by the left ventricular papillary muscle and the mitral annulus.Right ventricular non-exit flow origin IVAs are relatively rare in origin of left ventricular non-exit tract,mainly tricuspid annulus.3.Antiarrhythmic drugs are not effective in most patients,and Carto’s three-dimensional mapping guides the immediate success rate of RCA treatment.4.The left and right ventricular tract IVAs can be used to analyze the origin of the IVAs in the left and right ventricles by analyzing the chest lead R wave transition lead and the transition zone index.According to the QRS complex group shape and the QRS complex time limit,the PVCs can be roughly judged./VT in the origin of the left and right ventricles.