RECURRENT SUSTAINED VENTRICULAR TACHYCARDIA .4. PLEOMORPHISM
RECURRENT SUSTAINED VENTRICULAR TACHYCARDIA .4. PLEOMORPHISM
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DOI：
10.1161/01.cir.59.3.459
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发表时间：
1979-01-01
期刊：
影响因子：
37.8
通讯作者：
GREENSPAN, AM
中科院分区：
文献类型：
--
作者：
JOSEPHSON, ME;HOROWITZ, LN;GREENSPAN, AM
14例慢性持续性室性心动过速患者在电生理检查中观察到两种或两种以上形态不同的室性心动过速。这些患者中有9例具有多种形态的临床室性心动过速。在研究期间，13名患者同时表现出右束支分支传导阻滞（RBBB）和左束支分支传导阻滞（LBBB）形态。其余患者发生RBBB伴轴左右偏移。在4例患者中观察到自发的形态变化，并且可以通过心室刺激在所有14例患者中产生。12例患者RBBB和LBBB均起源于左心室，其中11例患者起源于左心室动脉瘤。在4例患者的两种形态和5例患者的1种形态期间，代表折返的舒张碎片活动不变。心外膜标测证实动脉瘤为2例多形室性心动过速的起源部位。室性心动过速通常是多形性的，在同一心动过速期间，多种形态通常代表不同的出口部位和/或心室激动。多形性室性心动过速常合并左室壁瘤。
Two or more morphologically distinct ventricular tachycardias were observed during electrophysiologic study in 14 patients with chronic sustained ventricular tachycardia. Nine of these patients had clinical ventricular tachycardia with multiple morphologies. During the study 13 patients manifested both right bundle branch block (RBBB) and left bundle branch block (LBBB) morphologies. The remaining patient had RBBB with both right and left axis deviation. Changing morphologies were observed spontaneously in 4 patients and could be produced in all 14 by ventricular stimulation. In 12 patients both RBBB nad LBBB originated in the left ventricle, and in 11 of these patients, from within a left ventricular aneurysm. Diastolic fragmented activity representing reentry was unchanged during both morphologies in 4 patients and during 1 morphology in 5 patients. Epicardial mapping confirmed the aneurysm as the site of origin of multiform ventricular tachycardias in 2 patients. Ventricular tachycardia is apparently frequently pleomorphic and multiple morphologies usually represent variable exit sites and/or ventricular activation during the same tachycardia. There is a frequent association of pleomorphic ventricular tachycardia with left ventricular aneurysm.