形态心电图标准在鉴别心室流出道室性心律失常中的价值

Value of electrocardiographic criteria in differential diagnosis of ventricular outflow tract ventricular arrhythmias

目的探讨形态心电图标准在心室流出道(VOT)室性心律失常(VA)中的鉴别价值。方法回顾性分析155例成功行射频导管消融治疗(以下简称消融治疗),并经三维标测或X线影像证实起源于左心流出道(LVOT)室性期前收缩/室性心动过速(PVC/VT)的心电图资料进行观察(观察组),使用系统抽样法选取同期成功行消融治疗的155例右心室流出道(RVOT)起源的PVC/VT进行对照(对照组),再根据起源的位置不同将观察组分为3个亚组:左冠窦(LCS)组、右冠窦(RCS)组、左冠窦下(ILCS)组。观察各组V_1、V_2导联R波振幅及时限比值、胸导联移行指数、V_2导联移行比、胸导联QRS波的移行情况,分析其对LVOT和RVOT及各亚组的PVC/VT鉴别价值,并计算各项指标的灵敏度、特异度、阳性预测值和阴性预测值。结果 LVOT和RVOT的PVC/VT的V_1、V_2导联R波振幅以及R波时限比值及V_2导联移行比、胸导联移行、胸前导联移行指数均有较为明显的差异。LVOT亚组分析显示:(1)符合胸导联移行指数<0,在LCS组、ILCS组及RCS组分别为92.39%(85/92)、90.91%(30/33)、90.00%(27/30)。(2)符合V_1导联的R波振幅比值≥0.3及时限比值≥0.5,在上述3组分别89.13%(82/92)、93.94%(31/33)、76.67%(23/30)。(3)符合V_2导联的R波振幅比值≥0.3及时限比值≥0.5,在上述3组分别为88.04%(81/92)、93.94%(31/33)、90.00%(27/30)。(4)V_2导联移行比>0.6,在上述3组分别为89.13%(82/92)、93.94%(31/33)、83.33%(25/30)。(5)PVC的胸导联移行在ILCS组有93.39%(31/33)在V_1导联之前,其余亚组均在V_1导联之后。(6)I导联QRS波形态LCS组及ILCS组以负向波为主呈rs/r S型,分别为78.26%(72/92)及81.81%(27/33),RCS组以正向波为主呈R或r型76.67%(23/30)。结论在VOT PVC/VT的形态心电图鉴别标准中,胸导联移行指数对于鉴别LVOT与RVOT起源,具有较高的灵敏度、特异度、阳性预测值及阴性预测值,应被优先选用。

Objective To evaluate the value of electrocardiographic（ECG） criteria in differential diagnosis of left ventricular outflow tract ventricular arrhythmias（LVOT） VAs.Methods The surface ECG pattern in 155 cases of left ventricular outflow ventricular premature contraction/ventricular tachycardia patients who underwent successful catheter ablation and compared with155 cases which origin from right ventricular outflow tract（RVOT） VAs patients.Five criteria of the indexes of the R-wave amplitude and duration,the precordialtransitionalzone index,the V2 transition ratio and precardialtransition for diagnosing LOVT and calculated their sensitivity,specificity cities,positive predictive values and negative predictive values.Results（1）There was significant different in the indexes of R-wave duration and R/S-wave amplitude in lead V and V2,the V2 transition ratio and precordial trans ition、the precordial transitional zone index between LVOT and RVOT.（2） The subgroup of the LVOT：①In accordance with the amplitude of R wave in lead V was larger than 0.3 and the time limit ratio was larger than 0.5：The LCS group、ILCS and RCS group were 89.13%（82/92）、90.91%（30/33）、90.00%（27/30）conform this standard.②In accordance with the amplitude of R wave in lead V2 was larger than 0.3 and the time limit ratio was larger than 0.5：The LCS group,ILCS and RCS group were 89.13%（82/92）、93.94%（31/33）、90.00%（27/30）conform this standard,③The TZ index ofthe precordial lead 〈0：The LCS group、ILCS and RCS group were 88.04%（81/92）、93.94%（31/33）,90.00%（27/30） conform this standard,④The V2 transition ratio：The LCS group、ILCS and RCS group were 89.13%（82/92）93.94%（31/33）,83.33%（25/30） ⑤PVC’s the precordial lead：The ILCS has 93.39%（31/33） small than V,The other group’s precordial lead were bigger than V1 ⑥the morphology of V1 a negative rs or rS morphology was recorded in most of LCS and ILCS group’s pation78.26%（72/92）and 81.81%（27/33）.a positive R、r、M morphology was recorded in most of group RCS patients76.67%（23/30） Conclusion The indexes of the r-wave amplitude 〈0.3and duration 〈 0.5 and the precordial transitional zone index≥0 are more effective than the other criterias in differential diagnosis of LVOT Vas.