不同心电图特征对特发性室性期前收缩右室流出道起源部位诊断价值比较

Electrocardiogram analysis in idiopathic right ventricular outflow tract arrhythmias

目的比较体表心电图鉴别右室流出道室性期前收缩具体起源点的诊断价值。方法分析经射频导管消融治疗室性期前收缩靶点明确为右室流出道的139例患者(其中右室流出道间隔部起源的111例,游离壁起源的28例)的体表心电图特点,以室性期前收缩时Ⅰ导联主波形态、QRS波时限、胸前导联移行及下壁三肢体导联有无顿挫进行分析,评估其对鉴别右室流出道室性期前收缩具体起源点的准确性。结果以室性期前收缩的QRS波宽度≥140 ms判断为右室流出道游离壁起源的灵敏度为86%,特异度为58%;以下壁三肢体导联均有顿挫或切迹判断为游离壁起源的灵敏度为64%,特异度为91%;以Ⅰ导联主波向上判断游离壁起源的灵敏度为86%,特异度为73%。结论 I导联主波方向及下壁三肢体导联有无顿挫能对鉴别游离壁还是间隔起源有较大实用价值。

AIM To determine the value of several surface electrocardiographic criteria for differentiating origins of right outflow tract ventricular arrhythmias. METHODS The present investigation studied ventricular arrhythmias in 139 patients who underwent successful catheter ablation in the right ventricular outflow tract （ septal, n = 111 ; free wall, n = 28 ）. Several electrocardiographic criteria including morphology of QRS in lead I, QRS duration, transitional zone in precordial leads and notch on R wave in inferior limb leads were used to judge the origin. RESULTS An R-wave duration ≥ 140 ms for predicting the origin from free wall had a sensitivity of 86% and specificity of 58%. Notch on the R-wave in inferior limb leads had a sensitivity of 64% and specificity of 91%. An R-wave in lead I had a sensitivity of 86% and specificity of 73%. CONCLUSION The morphology of QRS in lead I and the notch on R wave in inferior limb leads can accurately differentiate free wall from septal sites of right ventricular arrhythmia origins. These results potentially may be of significant value for guiding catheter ablation.