特发性室性心动过速的电描记图征象可从心大静脉远端消融。
An electrocardiographic sign of idiopathic ventricular tachycardia ablatable from the distal great cardiac vein.
机构信息
Department of Cardiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Department of Cardiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China.
出版信息
Heart Rhythm. 2020 Jun;17(6):905-914. doi: 10.1016/j.hrthm.2020.01.027. Epub 2020 Feb 4.
BACKGROUND
Idiopathic ventricular arrhythmias (IVAs) can originate from the distal great cardiac vein (DGCV). However, inadequate distinction sometimes occurs when electrocardiographic (ECG) characteristics are used to distinguish ventricular arrhythmias (VAs) arising from the DGCV from those arising from the adjacent left ventricular endocardium (LV ENDO).
OBJECTIVE
The purpose of this study was to identify distinct ECG features in patients with idiopathic IVAs originating from the DGCV.
METHODS
A total of 32 patients with IVAs originating from the DGCV were identified from a consecutive group of 874 patients undergoing IVAs ablation. Patients with IVAs from the DGCV were compared with a consecutively chosen series of 40 patients with IVAs in whom the site of origin was the adjacent LV ENDO.
RESULTS
Of the 32 patients with IVAs arising from the DGCV, 13 had distinct ECG characteristics compared with the LV ENDO group. Notches in both the upstroke and downstroke of the R wave in lead III were found in all 13 patients. However, the characteristic ECG pattern in lead III was found in 1 of 40 patients in the LV ENDO group. The ECG characteristic of both early notch and late notches in lead III has sensitivity of 40.6%, specificity of 97.5%, negative predictive value of 67.2%, and positive predictive value of 92.9% to predict VAs arising from the DGCV.
CONCLUSION
The distinct ECG characteristics of VAs originating from the DGCV can help differentiate from adjacent LV ENDO sites of origin.
背景
特发性室性心律失常（IVAs）可起源于远端心大静脉（DGCV）。然而，当使用心电图（ECG）特征来区分起源于 DGCV 的室性心律失常（VAs）与起源于相邻左心室心内膜（LV ENDO）的 VAs 时，有时会出现区分不足。
目的
本研究旨在确定起源于 DGCV 的特发性 IVAs 患者的独特 ECG 特征。
方法
从 874 例接受 IVAs 消融的连续患者中确定了 32 例起源于 DGCV 的 IVAs 患者。将起源于 DGCV 的 IVAs 患者与连续选择的 40 例起源于相邻 LV ENDO 的 IVAs 患者进行比较。
结果
在 32 例起源于 DGCV 的 IVAs 患者中，与 LV ENDO 组相比，有 13 例具有明显的 ECG 特征。在所有 13 例患者中，均在导联 III 的 R 波上升和下降时出现切迹。然而，在 LV ENDO 组的 40 例患者中，仅在 1 例患者中发现导联 III 的特征性 ECG 模式。导联 III 中早期切迹和晚期切迹的 ECG 特征对预测起源于 DGCV 的 VAs 的敏感性为 40.6%，特异性为 97.5%，阴性预测值为 67.2%，阳性预测值为 92.9%。
结论
起源于 DGCV 的 VAs 的独特 ECG 特征有助于与相邻的 LV ENDO 起源部位区分开来。
Zotero 插件