移行在V_3导联的流出道室性早搏/室性心动过速的心电图定位诊断方法及意义

Electrocardiographic criterion for distinguishing outflow tract premature ventricular beat or ventricular tachycardia with transitional lead at V_3

目的 探讨V2导联移行比与V1导联R波振幅指数联合V3导联R波偏移间期在流出道室性早搏/室性心动过速（PVB/VT）中定位诊断价值.方法 回顾性分析2007年8月至2012年11月在我院行三维心脏电解剖标测系统（CARTO）引导下射频消融治疗的52例流出道PVB/VT患者的心电图和电生理资料,用V2导联移行比与V1导联R波振幅指数联合V3导联R波偏移间期两种方法进行定位诊断.采用x2检验定位预测准确性.结果 （1）52例患者均在CARTO引导下成功射频消融治疗.消融靶点：起源于右心室流出道者31例,起源于左心室流出道者21例;（2）V2导联移行比对右心室流出道PVB/VT预测阳性为87.1％ （27/31）,对左心室流出道PVB/VT预测阳性为90.5％（19/21）,对流出道PVB/VT总的预测的准确性为88.5％（46/52）;（3）V1导联R波振幅指数及V3导联R波偏移间期对右心室流出道PVB/VT及左心室流出道PVB/VT预测阳性均达90.4％（47/52）以上;（4）两种方法对流出道PVB/VT定位诊断价值差异无统计学意义（χ2=0.11,P＞0.05）.结论 V2导联移行比及V1导联R波振幅指数联合V3导联R波偏移间期对流出道PVB/VT定位诊断均具有较高的准确性,有较好的临床应用价值.

Objective To inverstigate the V2 transition ratio and the R-wave deflection interval in lead V3 combining with R-wave amplitude index in lead V1 to distinguish outflow tract premature ventricular beat or ventrictdar tachyeardia with transitional lead at V3. Methods retrospectively analyzed electrocardiogram and electrophysiology from 52 patients with outflow tract premature ventficular beat and ventricular tachycardia between August 2007 and November 2012. Results （ 1 ） A total of 52 patients underwent radiofrequency catheter ablation with CARTO successfully, originating from the right ventricular outflow tract in 31 eases, originating from left ventfieular outflow tract in 21 cases; （2） The prediction accuracy was 87. 1% （27/31）in right ventricular outflow,90.5% （19/21） in left ventricular outflow tract and 88.5% （46/52） in right and left outflow tract with the V2 transition ratio; （3）The prediction accuracy was above 90.4% （47/52） in outflow tract premature ventricular beat or ventricular tachycardia with the R-wave deflection interval in lead V3 combining with R-wave amplitude index in lead V3（4） There was no significant difference between the two methods （χ2 =0. 11, P 〉0. 05）; Conclusion The V2 transition ratio and the R-wave deflection interval in lead V3 combining with R-wave amplitude index in lead V1 to distinguish outflow tract premature ventricular beat or ventrieular tachycardia with transitional lead at V3 is precise and good clinical application value.