ABSTRACT
Object@#To explore the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating from tricuspid annulus region.@*Methods@#Present study included 169 consecutive patients undergoing catheter ablation of VAs from tricuspid annulus origin in our department from August 2007 to September 2016. Based on the origin sites, the patients were divided into two subgroups, the free wall group (81 cases) and septal wall group (88 cases). Based on the location, patients in the free wall group were classified into anterolateral (22 cases), lateral (26 cases) and posterolateral (33 cases) subgroups. Patients in the septal group were classified into anteroseptal (10 cases), midseptal (71 cases) and posteroseptal (7 cases) subgroups. We analyzed the electrocardiographic features of these patients and in 87 patients with PVCs/VT originating from right ventricular outflow tract.@*Results@#(1) A positive R wave inⅠ, aVL, V5-V6 leads were found among most of patients, only few cases originating from tricuspid annulus anteroseptum group and tricuspid annulus anterolateral group demonstrated qr or qs pattern in aVL lead. 97.53% (79/81) patients demonstrated rS pattern in V1-V3 leads with VAs originating from tricuspid annulus free wall, and 9/10 patients demonstrated rS pattern in V1 lead with VAs originating from anteroseptum, and 97.44% (76/78) patients demonstrated QS pattern in V1 lead with VAs originating from midseptum and posteroseptum. Precordial lead transition zone was on or behind V3 for tricuspid annulus free wall group (96.3%, 78/81), but in front of V3 for tricuspid annulus septum wall group (47.73%, 42/88) (P<0.01). The S wave's amplitude smaller than-1.81 mV in lead V2 can be used as a cutoff value to identify if PVC/VT is originating from free wall or septum of TA. R wave in inferior wall leads was found among 98.85% (86/87) patients with PVCs/VT originating from right ventricular outflow tract.@*Conclusion@#A positive R wave in Ⅰ, aVL, V5-V6 leads was found among most of patients with idiopathic ventricular arrhythmias originating from the tricuspid annulus regions, but VAs originating from different portions of tricuspid annulus area have distinct electrocardiographic characteristics.
ABSTRACT
The purpose of this study was to explore the clinical and electrocardiographic characteristics of infarctional ventricular ectopic beats (IVEBs).Thirty-eight acute myocardial infarction (AMI) patients with IVEB and 109 AMI patients without IVEB were analyzed. The morphological changes of QRS complex, ST segment, and T wave were compared to IVEB with sinus rhythm from the same period and fully evolved phase.An IVEB QRS complex often revealed the right bundle branch block morphology, in addition to Q wave AMI; no-Q wave AMI also had IVEB. Single-factor analysis found that IVEB often appeared in early AMI (<6âhours), and they were more frequent in inferoposterior with/without right ventricular involvement, large area AMI and thrombolytic reperfusion than in anterior or anteroseptal myocardial infarction, small area AMI, and unthrombolytic nonreperfusion. Multifactors no conditional logistic regression analysis revealed a positive correlation between IVEB and early AMI, AMI size, Killip heart function degree, inferoposterior with/without right ventricular involvement, and thrombolytic reperfusion. The Q wave of IVEB was wider, and the ST segment elevation was higher than those of the same period in sinus rhythms. The infarctional morphological changes of IVEB could be found before the same period in sinus rhythm and elevated myocardial enzymes.IVEBs were not rare. They were useful for early diagnosis and location of AMI.
