心电图对流出道室性心律失常起源部位的预测价值

Predictive value of electrocardiogram on the origin site of outflow tract ventricular arrhythmias

目的分析已行导管消融术的流出道室性心律失常患者的临床特点及电生理学特点,探讨三种已知心电指标:移行区指数、V2S/V3R指数、R波时限振幅指数对OTVA起源部位预测价值的优劣性,为临床诊疗提供参考依据。方法回顾性分析宁夏医科大学总医院2011年1月1日至2017年12月31日已行导管消融术且术中心内电生理证实为OTVA的54例住院患者病例资料,分析其术前12导联体表心电图,测量并计算R波时限指数与振幅指数、V2S/V3R指数、胸前导联移行区指数。通过以上指标判断心电图对于术前预测OTVA起源部位的灵敏度、特异度、阳性预测值、阴性预测值、准确度。结果以R波时限指数≥50%且振幅指数≥30%;V2S/V3R指数≤1.5;移行区指数<0为标准鉴别OTVA起源于LVOT时,三种指标的灵敏度、特异度、阳性预测值、阴性预测值和准确度同名指标间的差异均无统计学意义。结论三种心电图指标预测OTVA流出道起源的预测价值无显著差异。

AIM To analyze clinical and electrophysiological characteristics of outflow tract ventricular arrhythmias(OTVA)in patients who have undertaken catheterablation.To evaluate superiority in the origin of OTVA with known clectrocardiogram(ECG)indexes such as the transitional zone(TZ)index,Swave amplitude in lead V2 divided by R-wave amplitude in lead V3(V2 S/V3 R),and R-wave durationindex and R/S-wave amplitude index.To provide a basis for clinical diagnosis and treatment.METHODS Retrospective analysis was performed on the data of 54 inpatients admitted to the general hospital of Ningxia Medical University who had undertaken catheter ablation on January 1,2011,to December 31,2017 and who were confirmed to be OTVA by electrophysiology in the operation center.The preoperative 12-lead surface ECG of these patients.R-waveduration index,R/S-wave amplitude index,V2 S/V3 R index,and TZindex were observed,measured and calculated.The sensitivity,specificity,positive predictive value and negative predictive value,accuracy of ECG for preoperative prediction of OTVA origin site were determined by the above indicators.RESULTS The difference of sensitivity,specificity,positive predictive value,negative predictive value and accuracy were not statistically significant when identifying the OTVA originated from the left and right ventricular outflow tract with the R-wave duration index and R/S-wave amplitude index,V2 S/V3 R index and TZ index.CONCLUSION There is no significant difference in the predictive value of the three electrocardiogram indexes in predicting the origin of OTVA outflow tract.