基于室性期前收缩的 QRS 形态和复极时间来区分起源于右或左心室流出道的心律失常。

Differentiation of arrhythmia originating from the right or left ventricular outflow tract based on the QRS morphology of premature ventricular beats and duration of repolarisation.

机构信息

1st Chair and Department of Cardiology, Upper Silesian Medical Centre, Medical University of Silesia, Katowice, Poland.

出版信息

Kardiol Pol. 2013;71(7):723-9. doi: 10.5603/KP.2013.0160.

DOI:10.5603/KP.2013.0160

PMID:23907906

Abstract

BACKGROUND

Premature ventricular beats (PVBs) and monomorphic ventricular tachycardia originating from the right ventricular outflow tract (RVOT) are the most frequent forms of idiopathic ventricular arrhythmias, but arrhythmia originating from the left ventricular outflow tract (LVOT) may be found in about 10% of these patients.

AIM

To compare electrocardiographic (ECG) patterns and duration of repolarisation after PVBs originating from the left and right superior part of the interventricular septum which were successfully treated with radiofrequency catheter ablation.

METHODS

We studied 62 patients who did not receive antiarrhythmic drug treatment before ablation, including 50 patients with RVOT arrhythmia (21 males, mean age 42 ± 14 years, left ventricular ejection fraction [LVEF] 61 ± 6%) and 12 patients with LVOT arrhythmia (3 males, mean age 41 ± 17 years, LVEF 59 ± 9%). Pre-ablation 24-h Holter ECG recordings were analysed for the total number of PVBs. In addition, we evaluated ectopic beat QRS duration, prematurity index and duration of repolarisation (QT interval, JT interval and TpeakTend values uncorrected for the heart rate) based on ten random daytime PVBs during a period of stable sinus rhythm at a rate of 60-70 bpm.

RESULTS

The study groups did not differ by age, LVEF, heart rate and the number of PVBs. RVOT arrhythmia was characterised by a lower prematurity index (0.59 ± 0.11 vs. 0.72 ± 0.09, p = 0.001) and a lower R/S ratio in leads V1-V3 (p < 0.01 for each lead). QRS duration of right-sided PVBs was shorter compared to that of left-sided PVBs (147 ± 13 vs. 166 ± 13 ms, p = 0.002), QT and JT intervals were similar (QT: 422 ± 32 vs. 429 ± 27 ms, p = 0.35; JT: 272 ± 27 vs. 266 ± 27 ms, p = 0.31), and TpeakTend was shorter in RVOT arrhythmia (100 ± 10 vs. 110 ± 6 ms, p = 0.01). Combination of R > S in lead V3 and TpeakTend-PVB > 110 ms identified LVOT arrhythmia with a sensitivity of 75% and specificity of 96%.

CONCLUSIONS

Ventricular arrhythmias originating from the left or right superior part of the interventricular septum are not only characterised by different ECG patterns of ventricular ectopic beats but also show significant differences in the repolarisation phase.

摘要

背景

室性早搏（PVB）和起源于右心室流出道（RVOT）的单形性室性心动过速是最常见的特发性室性心律失常形式，但起源于左心室流出道（LVOT）的心律失常在这些患者中约占 10%。

目的

比较起源于间隔上部左右心室的室性早搏的心电图（ECG）模式和复极持续时间，这些早搏均通过射频导管消融成功治疗。

方法

我们研究了 62 名在消融前未接受抗心律失常药物治疗的患者，包括 50 名 RVOT 心律失常患者（21 名男性，平均年龄 42 ± 14 岁，左心室射血分数[LVEF]61 ± 6%）和 12 名 LVOT 心律失常患者（3 名男性，平均年龄 41 ± 17 岁，LVEF 59 ± 9%）。在窦性心律稳定、心率 60-70 次/分时，对 24 小时 Holter ECG 记录中的总室性早搏次数进行分析。此外，我们评估了异位搏动 QRS 持续时间、过早指数和复极时间（QT 间期、JT 间期和未校正心率的 TpeakTend 值），基于 10 个随机日间 PVB。

结果

研究组在年龄、LVEF、心率和室性早搏数量方面无差异。RVOT 心律失常的过早指数较低（0.59 ± 0.11 与 0.72 ± 0.09，p = 0.001），V1-V3 导联的 R/S 比值较低（每个导联均 p < 0.01）。右侧 PVB 的 QRS 持续时间较左侧 PVB 短（147 ± 13 与 166 ± 13 ms，p = 0.002），QT 和 JT 间期相似（QT：422 ± 32 与 429 ± 27 ms，p = 0.35；JT：272 ± 27 与 266 ± 27 ms，p = 0.31），RVOT 心律失常的 TpeakTend 较短（100 ± 10 与 110 ± 6 ms，p = 0.01）。V3 导联 R>S 和 TpeakTend-PVB > 110 ms 的组合对 LVOT 心律失常的敏感性为 75%，特异性为 96%。