邻近房室环间隔不同部位室性心律失常的心电图鉴别流程

Electrocardiographic differential process of idiopathic ventricular arrhythmias originating from different areas of ventricular septum adjacent to atrioventricular annulus

目的探讨邻近房室环间隔(VSAVA)不同部位室性心律失常(VA)的心电图特点及鉴别流程。方法2010年8月至2021年10月在温州医科大学附属第二医院经电生理检查与消融治疗符合邻近VSAVA起源的特发性VA患者287例纳入本研究,其中男169例,年龄(61.50±15.67)岁,年龄范围12~86岁,根据胸部X线片影像及三维标测定位分为2组:①邻近三尖瓣环间隔(VSTA)组226例,其中男132例,年龄(61.92±15.88)岁;②邻近二尖瓣环间隔(VSMA)组61例,其中男37例,年龄(59.93±15.07)岁。分析并比较两组患者心电图QRS时限的特征及变化规律。结果消融成功261例(90.94%,261/287)。分析其心电图特征,发现:①若以V1导联呈QR、Qr、qr、qR型;QS型与rS型分别作为鉴别邻近VSMA、邻近VSTA中下部与其上部起源VA的指标,其敏感性、特异性、阳性与阴性预测值分别为75.41%(46/61)、95.13%(215/226)、80.70%(46/57)、93.48%(215/230);93.71%(179/191)、85.42%(82/96)、92.75%(179/193)、87.23%(82/94);68.57%(24/35)、98.81%(249/252)、88.89%(24/27)、95.77%(249/260);②若以RV2/SV2比值>5预测VA起源于邻近VSMA的敏感性、特异性、阳性和阴性预测值分别为98.36%(60/61)、92.03%(208/226)、76.92%(60/78)和99.52%(208/209),提示RV2/SV2比值>5预测VA起源于邻近VSMA部VA的价值优于V1导联呈QR、Qr、qr、qR型。结论射频消融治疗邻近VSAVA部VA安全有效,不同部位心电图特征亦异,且有一定的变化规律。掌握这些特点对术前初步判定其起源部位,缩短手术时间,提高消融术成功率将有所裨益。

Objective To investigate the electrocardiographic(ECG)characteristics and differential process of ventricular arrhythmias(VA)originating from ventricular septum adjacent to atrioventricular annulus(VSAVA).Methods From August 2010 to October 2021,Two hundred and eighty-seven patients[male 169;age(61.50±15.67)years old,range 12-86 years old]were confirmed as origin from VSAVA in The Second Affitiated Hospital of Wenzholl Meel.According to both fluoroscopy and three-dimensional mapping,the VA were divided into two groups.①ventrcular septum adjacent adjacent tricuspid annulus(VSTA)group:226 cases,male 132,age(61.92±15.88)years old;②In the ventricular septum adjacent mitral annulus(VSMA)group:61 cases male 37,age(59.93±15.07)years old.Characteristics of ECG were analyzed.Results The success rate for RFCA was 90.94%(261/287),The QR,Qr,qr,qR wave in V1 lead indicate septum near MA origin;QS wave in V1 lead indicate mid-inferior septum near TA origin;rS wave in V1 lead indicate superior septum near TA origin,the sensitivity,specificity,positive predictive value(PPV)and negative predictive values(NPV)were 75.41%(46/61)、95.13%(215/226)、80.70%(46/57)、93.48%(215/230);93.71%(179/191),85.42%(82/96),92.75%(179/193),87.23%(82/94);68.57%(24/35),98.81%(249/252),88.89(24/27),95.77%(249/260).RV2/SV2 ratio>5 indicate septum near VSMA origin,the sensitivity,specificity,PPV and NPV were 98.4%(60/61),92.0%(208/226),76.9%(60/78)99.5%(208/209).RV2/SV2 ratio>5 has better predictability for VA origin from septum near VSMA origin than QR,Qr,qr,qR wave in V1 lead.Conclusion Distinctive ECG features of VA originating from VSAVA is beneficial to shorten the operation time and improve the success rate of ablation.