Liu Zheng, Jia Yu-He, Ren Lan, Fang Pi-Hua, Zhou Gong-Bu, He Jia, Zhang Shu
Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Cardiology, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
Pacing Clin Electrophysiol. 2016 Feb;39(2):173-81. doi: 10.1111/pace.12781. Epub 2015 Dec 1.
Multiple intercostal recordings were supposed to get a more comprehensive view of the depolarization vector of the outflow tract ventricular arrhythmia (OT-VA), which may help to identify the OT-VA more accurately. This study was undertaken to develop a more accurate electrocardiogram (ECG) criterion for differentiating between left and right OT-VA origins.
We studied OT-VA with a left bundle branch block pattern and inferior axis QRS morphology in 47 patients with successful catheter ablation in the right ventricular OT (RVOT; n = 37) or aortic coronary cusp (ACC; n = 10). Superior and inferior precordial leads were taken together with the routine 12-lead ECG. The ECG during the OT-VA and during sinus beats were analyzed. Transition ratio, transition zone (TZ) index, R/S amplitude ratio, and R-wave duration ratio were measured in the regular, superior, and inferior precordial leads.
The combined TZ index, TZ index inferior was significantly smaller, while the V2 inferior transition ratio was significantly larger for ACC origins than RVOT origins (P < 0.05). The area under the curve for the combined TZ index by a receiver operating characteristic analysis was 0.974, which was significantly larger than other parameters. A cutoff value ≤0.25 predicted an ACC origin with 94% sensitivity and 100% specificity. This advantage of the parameter over others also held true for a subanalysis of OT-VAs with a lead V3 precordial transition or TZ index = 0.
The combined TZ index outperformed other ECG criteria to differentiate left from right OT-VA origins.
多个肋间记录被认为可以更全面地观察流出道室性心律失常（OT-VA）的去极化向量，这可能有助于更准确地识别OT-VA。本研究旨在制定一种更准确的心电图（ECG）标准，以区分左、右OT-VA起源。
我们研究了47例在右心室OT（RVOT；n = 37）或主动脉冠状动脉窦（ACC；n = 10）成功进行导管消融的患者中具有左束支传导阻滞图形和下轴QRS形态的OT-VA。除常规12导联心电图外，还采集了胸前导联的上下导联。分析了OT-VA期间和窦性心律期间的心电图。在规则、胸前导联的上、下导联中测量移行率、移行区（TZ）指数、R/S振幅比和R波持续时间比。
ACC起源的联合TZ指数、下TZ指数明显较小，而V2下移行率明显大于RVOT起源（P < 0.05）。通过受试者工作特征分析，联合TZ指数的曲线下面积为0.974，明显大于其他参数。截断值≤0.25预测ACC起源的敏感性为94%，特异性为100%。该参数相对于其他参数的这一优势在对胸前导联V3移行或TZ指数 = 0的OT-VA进行亚分析时也成立。
联合TZ指数在区分左、右OT-VA起源方面优于其他心电图标准。
