Jackson Larry R, Piccini Jonathan P, Daubert James P, Hurwitz Koweek Lynne M, Atwater Brett D
Section of Cardiac Electrophysiology, Duke University School of Medicine, Durham, NC, 27705, USA,
J Interv Card Electrophysiol. 2015 Jun;43(1):5-12. doi: 10.1007/s10840-015-9984-5. Epub 2015 Feb 27.
While the accuracy of roentography for evaluation of lead tip position compared with three-dimensional imaging techniques has been well described, there remains considerable variability in the interpretation of the reproducibility of standard x-ray for right ventricular (RV) and left ventricular (LV) lead position. The aim of this study was to evaluate the accuracy and reliability of right ventricular (RV) and left ventricular (LV) lead tip position as determined by board-certified cardiac electrophysiologists (EP) using standard x-ray views.
EP interpretations of RV and LV lead tip position using standard x-ray views (posterior-anterior, lateral, and left anterior oblique) were compared to thoracic computed tomography (CT). The accuracy of x-ray interpretation was compared to the reference CT location, and the reproducibility of x-ray interpretation was tested using the free-marginal Kappa statistic.
A total of 58 EPs were invited to participate in the survey with a response rate of 43 % (25/58). The agreement between x-ray and CT lead tip position (accuracy) was 37 % for RV lead, 33 % for longitudinal LV lead, and 41 % for short axis LV lead. Reproducibility was 64 % for RV lead tip (k = 0.46), 58 % for longitudinal LV lead tip (k = 0.37), and 39 % for short axis LV lead tip (k = 0.24).
Conventional roentography is limited in its ability to accurately and reliably determine pacing lead tip position.
虽然与三维成像技术相比，X线摄影评估导线尖端位置的准确性已得到充分描述，但对于标准X线评估右心室（RV）和左心室（LV）导线位置的可重复性的解读仍存在很大差异。本研究的目的是评估经认证的心脏电生理学家（EP）使用标准X线视图确定的右心室（RV）和左心室（LV）导线尖端位置的准确性和可靠性。
将EP使用标准X线视图（后前位、侧位和左前斜位）对RV和LV导线尖端位置的解读与胸部计算机断层扫描（CT）进行比较。将X线解读的准确性与参考CT位置进行比较，并使用自由边缘Kappa统计量测试X线解读的可重复性。
共邀请58名EP参与调查，回复率为43%（25/58）。X线与CT导线尖端位置之间的一致性（准确性），RV导线为37%，LV纵向导线为33%，LV短轴导线为41%。RV导线尖端的可重复性为64%（k = 0.46），LV纵向导线尖端为58%（k = 0.37），LV短轴导线尖端为39%（k = 0.24）。
传统X线摄影在准确可靠地确定起搏导线尖端位置方面能力有限。
