比较透视和心电图标准与三维超声心动图对起搏器导线植入的准确性。
Accuracy of fluoroscopic and electrocardiographic criteria for pacemaker lead implantation by comparison with three-dimensional echocardiography.
机构信息
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
出版信息
J Am Soc Echocardiogr. 2012 Jul;25(7):796-803. doi: 10.1016/j.echo.2012.04.010. Epub 2012 May 19.
BACKGROUND
Fluoroscopic and electrocardiographic (ECG) criteria for the documentation of pacing lead positioning (apical and alternative sites) have been described, but data regarding their accuracy are lacking.
METHODS
Fifty patients (27 men; mean age, 76 ± 9 years) with permanent right ventricular (RV) pacing leads were included. RV lead position was classified as apical, mid septal, mid RV free wall, RV outflow tract (RVOT) septal, or RVOT free wall. Exact anatomic lead position was documented using three-dimensional (3D) transthoracic echocardiography (TTE). Cohen's κ coefficient was used to assess agreement between fluoroscopic or ECG criteria and 3D TTE.
RESULTS
True lead positions were as follows: 15 apical, 24 mid septal, three mid RV free wall, and eight RVOT septal wall; no leads were implanted into the RVOT free wall. Fluoroscopy (κ = 0.56; 95% confidence interval [CI], 0.37-0.76) and electrocardiography (κ = 0.43; 95% CI, 0.25-0.60) had moderate overall agreement with 3D TTE. Fluoroscopy had moderate agreement with 3D TTE for apical (κ = 0.57; 95% CI, 0.32-0.83), mid septal (κ = 0.48; 95% CI, 0.25-0.72), and mid free wall sites (κ = 0.54; 95% CI, 0.08-1.00) and moderate to good agreement for the RVOT septal wall (κ = 0.61; 95% CI, 0.30-0.90). Fluoroscopy misclassified as mid septal six of the 15 RV apical leads. ECG criteria had moderate agreement with 3D TTE for apical positions (κ = 0.55; 95% CI, 0.34-0.77) and RVOT sites (κ = 0.47; 95% CI, 0.21-0.73). Electrocardiography misclassified as apical 10 and as RVOT six of the 24 mid septal leads.
CONCLUSIONS
Fluoroscopic and ECG criteria are only moderately accurate in discriminating between RV apical, mid septal, mid free wall, and RVOT pacing sites. These data suggest that both fluoroscopy and electrocardiography may not be adequate techniques for the correct documentation of RV pacing lead position for routine clinical practice or research purposes.
背景
已经描述了用于记录起搏导线位置（心尖和替代部位）的透视和心电图（ECG）标准，但缺乏关于其准确性的数据。
方法
纳入 50 名（男 27 名；平均年龄 76 ± 9 岁）接受永久性右心室（RV）起搏导线的患者。RV 导线位置被分类为心尖、中隔、中 RV 游离壁、RV 流出道（RVOT）间隔或 RVOT 游离壁。使用三维（3D）经胸超声心动图（TTE）准确记录确切的导线位置。使用 Cohen's κ 系数评估透视或 ECG 标准与 3D TTE 之间的一致性。
结果
真实的导线位置如下：15 个心尖、24 个中隔、3 个中 RV 游离壁和 8 个 RVOT 间隔壁；没有导线植入 RVOT 游离壁。透视（κ=0.56；95%置信区间[CI]，0.37-0.76）和心电图（κ=0.43；95%CI，0.25-0.60）与 3D TTE 具有中等总体一致性。透视对于心尖（κ=0.57；95%CI，0.32-0.83）、中隔（κ=0.48；95%CI，0.25-0.72）和中 RV 游离壁部位（κ=0.54；95%CI，0.08-1.00）与 3D TTE 具有中度一致性，对于 RVOT 间隔壁具有中度至良好的一致性（κ=0.61；95%CI，0.30-0.90）。透视将 15 个 RV 心尖导联中的 6 个错误分类为中隔。心电图标准对于心尖位置（κ=0.55；95%CI，0.34-0.77）和 RVOT 部位（κ=0.47；95%CI，0.21-0.73）与 3D TTE 具有中度一致性。心电图将 24 个中隔导联中的 10 个和 6 个错误分类为心尖导联。
结论
透视和心电图标准在区分 RV 心尖、中隔、中 RV 游离壁和 RVOT 起搏部位方面仅具有中等准确性。这些数据表明，透视和心电图可能都不是用于正确记录 RV 起搏导线位置的常规临床实践或研究目的的合适技术。
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