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, China.
Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China.
Cardiology. 2020;145(11):710-719. doi: 10.1159/000507360. Epub 2020 Aug 25.
There are several electrocardiographic algorithms to predict the origin of idiopathic outflow tract ventricular arrhythmias (OT-VAs). This study aimed to develop a more accurate and efficient stepwise electrocardiographic algorithm to discriminate left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin.
We analyzed 12-lead electrocardiographic characteristics of 173 consecutive OT-VAs patients who underwent successful radiofrequency catheter ablation in the RVOT (n = 124) or LVOT (n = 49). Based on the areas under the receiver operating characteristic curves, the combination of transitional zone (TZ) index <0 and V2S/V3R index ≤1.5 exhibited 93.5% sensitivity, 85.9% specificity, and 87.3% accuracy. A further analysis was performed in the 71 OT-VAs with a V3-lead precordial transition. The sensitivity, specificity, and accuracy of the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms were 91.7, 83.1, and 85.9%, respectively. In the prospective evaluation, the combination of TZ index and V2S/V3R index could identify the correct origin sites with 91.2% accuracy in the overall analysis, and the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms exhibited 94% accuracy in V3-lead precordial transition.
The combination of TZ index <0 and V2S/V3R index ≤1.5 is a simple and efficient stepwise electrocardiographic algorithm for predicting LVOT origin. For the OT-VAs with a V3-lead precordial transition, the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms would be a better choice.
有几种心电图算法可用于预测特发性流出道室性心律失常（OT-VA）的起源。本研究旨在开发一种更准确、更有效的逐步心电图算法，以区分左心室流出道（LVOT）和右心室流出道（RVOT）起源。
我们分析了 173 例连续接受 RVOT（n=124）或 LVOT（n=49）成功射频导管消融的 OT-VA 患者的 12 导联心电图特征。根据受试者工作特征曲线下面积，过渡区（TZ）指数<0和 V2S/V3R 指数≤1.5 的组合具有 93.5%的敏感性、85.9%的特异性和 87.3%的准确性。对 71 例 V3 导联胸前过渡的 OT-VA 进行了进一步分析。整合 V2S/V3R 指数≤1.5 和 V3 导联 R 波偏移间期>80ms 的敏感性、特异性和准确性分别为 91.7%、83.1%和 85.9%。在前瞻性评估中，整体分析中 TZ 指数和 V2S/V3R 指数的组合可正确识别起源部位，准确率为 91.2%，而 V2S/V3R 指数≤1.5 与 V3 导联 R 波偏移间期>80ms 的整合在 V3 导联胸前过渡时表现出 94%的准确性。
TZ 指数<0 和 V2S/V3R 指数≤1.5 的组合是预测 LVOT 起源的一种简单而有效的逐步心电图算法。对于 V3 导联胸前过渡的 OT-VA，整合 V2S/V3R 指数≤1.5 和 V3 导联 R 波偏移间期>80ms 将是更好的选择。
