特发性流出道室性期前收缩体表心电图207例分析

Surface electrocardiogram analysis of 207 outflow tract premature ventricular contractions

目的:分析特发性流出道室性期前收缩(室早,premature ventricular contractions,PVC)的体表心电图定位特征,进而指导射频导管消融。方法:回顾性分析连续207例接受射频消融治疗、术中经电生理检查和(或)心室造影,证实起源于左心室流出道(LVOT)或右室流出道(RVOT)室性心律失常(VAs)患者体表心电图特点,测量胸前导联R波、S波的振幅,分析胸前导联QRS波群R/S转换与起源部位的关系,R/S转换在V3导联时计算V2导联R/S振幅比值。结果:VAs时胸前导联R/S转换在V2或以前的VAs患者18(男8,女10)例,年龄23～87(44±17)岁,起源于LVOT 17例,特异性99%,敏感性68%。胸前导联R/S转换在V4或以后的共113(男43,女70)例,年龄4～73(42±14)岁,均起源于RVOT,特异性100%,敏感性62%。胸前导联R/S转换在V3的VAs患者76(男25,女51)例,年龄17～82(46±13)岁;起源于RVOT 68例,起源于LVOT 8例,V2导联R/S值比分别为0.32±0.17vs.0.64±0.21(P<0.05)。结论:流出道室早胸前导联R/S转换早于V2和晚于V4分别提示起源于LVOT和RVOT的特异性和敏感性均较高。转换在V3时,起源于LVOT的VAs胸前V2导联的R/S比值明显高于起源于RV-OT者。

AIM： To study the surface electrocardiogram（ECG） characteristics of outflow tract ventricular arrhythmias as possible guidance for catheter ablation.METHODS： ECG characteristics in 207 consecutive patients who underwent radiofrequency catheter ablation of VT/PVCs originating from LVOT or RVOT were analyzed,respectively.The amplitudes of R wave and S wave of precordial leads were measured.The relationship between the origin site and the precordial lead at which R/S translated was analyzed and R/S amplitude ratios were calculated.RESULTS： The number of patients whose transition of R/S on precordial leads was before lead V2,in lead V3 and after lead V4 were 18 [aged（44±17） years],76 [aged（46±13） years] and 113 [aged（42±14） years],respectively.In the 18 cases of R/S wave transition before lead V2,LVOT origin was defined in 17 patients（specificity 99%,sensitivity 68%,positive predictive value 94% and negative predictive value 96%）.In the 113 cases of R/S transition after lead V4,RVOT origin was defined in all the patients（specificity 100%,sensitivity 62%,positive predictive value 100% and negative predictive value 26%.In the 76 cases of R/S wave transition in lead V3,RVOT and LVOT origin were defined in 68 patients and eight patients,respectively.The lead V2 R/S amplitude ratios from RVOT and LVOT were 0.32±0.17 vs.0.64±0.21（P〈0.05） respectively.CONCLUSIONS： The specificity of identifying the origin of ventricular arrhythmias from LVOT by R/S transition before lead V2 is high as well as the specificity and sensitivity of identifying origin from RVOT by R/S transition after lead V4.In the cases of R/S wave transition in lead V3,R/S amplitude ratios of the VAs originating from LVOT were higher than those from RVOT.