Xia Yu, Liu Zheng, Liu Jun, Li Xiaofeng, Zhang Hao, Fu Lijuan, Yu Miao, Fang Pihua
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Heart Rhythm. 2020 Dec;17(12):2164-2171. doi: 10.1016/j.hrthm.2020.07.006. Epub 2020 Jul 10.
The initial depolarization vector of outflow tract (OT) ventricular arrhythmia (VA) varies in different origins, which may help to predict OT-VA origin more accurately.
The purpose of this study was to develop a more accurate electrocardiographic (ECG) criterion for differentiating between left and right OT-VA origins.
We studied 275 patients with successful ablation in the right ventricular outflow tract (RVOT) (n = 207) or left ventricular outflow tract (LVOT) (n = 68) in the development cohort. Amplitude of the QRS complex within initial 40 ms (QRS) in precordial leads was measured. A novel criterion for identifying OT-VA origin was developed based on the development cohort. Predictive performance of novel criterion was further validated by comparing with previous ECG criteria (VS/VR index, V transition ratio, and transition zone index) in the validation cohort with 107 patients (RVOT 75; LVOT 32).
QRS of identical precordial leads were significantly greater in the LVOT group than the RVOT group (P <.05). In the development cohort, QRS of V (VQRS) exhibited the greatest area under the curve of 0.950, with cutoff ≥0.52 mV predicting LVOT origin (sensitivity 86.0%; specificity 94.6%). In the validation cohort, VQRS ≥0.52 mV outperformed previous criteria in predictive performance (accuracy 90.7%; sensitivity 84.4%; specificity 93.3%). This advantage of VQRS over previous criteria also held true for subgroups of transition zone index = 0 and V R/S transition.
VQRS is a novel and accurate ECG criterion to predict OT-VA origin that outperforms previous criteria.
流出道（OT）室性心律失常（VA）的初始去极化向量在不同起源部位有所不同，这可能有助于更准确地预测OT-VA的起源。
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的起源。
我们在开发队列中研究了275例在右心室流出道（RVOT）（n = 207）或左心室流出道（LVOT）（n = 68）成功消融的患者。测量胸前导联初始40 ms内QRS波群的振幅（QRS）。基于开发队列制定了一种识别OT-VA起源的新标准。通过与107例患者（RVOT 75例；LVOT 32例）的验证队列中的先前ECG标准（VS/VR指数、V移行比率和移行区指数）进行比较，进一步验证了新标准的预测性能。
LVOT组胸前导联相同的QRS波群明显大于RVOT组（P <.05）。在开发队列中，V导联的QRS波群（VQRS）曲线下面积最大，为0.950，截断值≥0.52 mV预测LVOT起源（敏感性86.0%；特异性94.6%）。在验证队列中，VQRS≥0.52 mV在预测性能方面优于先前标准（准确性90.7%；敏感性84.4%；特异性93.3%）。VQRS相对于先前标准的这一优势在移行区指数 = 0和V R/S移行的亚组中也成立。
VQRS是一种新颖且准确的预测OT-VA起源的ECG标准，优于先前标准。
