Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Clin Cardiol. 2021 Jan;44(1):100-107. doi: 10.1002/clc.23511. Epub 2020 Dec 10.
The electrophysiology algorithm for localizing left or right origins of outflow tract ventricular arrhythmias (OT-VAs) with lead V transition still needs further investigation in clinical practice.
Lead I R-wave amplitude is effective in distinguishing the left or right origin of OT-VAs with lead V transition.
We measured lead I R-wave amplitude in 82 OT-VA patients with lead V transition and a positive complex in lead I who underwent successful catheter ablation from the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT). The optimal R-wave threshold was identified, compared with the V S/V R index, transitional zone (TZ) index, and V transition ratio, and validated in a prospective cohort study.
Lead I R-wave amplitude for LVOT origins was significantly higher than that for RVOT origins (0.55 ± 0.13 vs. 0.32 ± 0.15 mV; p < .001). The area under the curve (AUC) for lead I R-wave amplitude as assessed by receiver operating characteristic (ROC) analysis was 0.926, with a cutoff value of ≥0.45 predicting LVOT origin with 92.9% sensitivity and 88.2% specificity, superior to the V S/V R index, TZ index, and V transition ratio. VAs in the LVOT group mainly originated from the right coronary cusp (RCC) and left and right coronary cusp junction (L-RCC). In the prospective study, lead I R-wave amplitude identified the LVOT origin with 92.3% accuracy.
Lead I R-wave amplitude provides a useful and simple criterion to identify RCC or L-RCC origin in OT-VAs with lead V transition.
用于定位流出道室性心律失常（OT-VA）左或右起源的电生理算法在临床实践中仍需要进一步研究。
I 导联 R 波振幅可有效区分具有 V 导联过渡的 OT-VA 的左或右起源。
我们测量了 82 例具有 V 导联过渡和 I 导联正性复合波的 OT-VA 患者的 I 导联 R 波振幅，这些患者均经导管消融成功治疗右心室流出道（RVOT）和左心室流出道（LVOT）起源的 OT-VA。确定了最佳 R 波阈值，并与 V S/V R 指数、过渡区（TZ）指数和 V 过渡比进行了比较，并在一项前瞻性队列研究中进行了验证。
LVOT 起源的 I 导联 R 波振幅明显高于 RVOT 起源（0.55±0.13 比 0.32±0.15 mV；p<0.001）。ROC 分析评估的 I 导联 R 波振幅的曲线下面积（AUC）为 0.926，截断值≥0.45 预测 LVOT 起源的灵敏度为 92.9%，特异性为 88.2%，优于 V S/V R 指数、TZ 指数和 V 过渡比。LVOT 组的 VA 主要起源于右冠状动脉瓣（RCC）和左右冠状动脉瓣交界处（L-RCC）。在前瞻性研究中，I 导联 R 波振幅对 LVOT 起源的识别准确率为 92.3%。
I 导联 R 波振幅为具有 V 导联过渡的 OT-VA 中 RCC 或 L-RCC 起源提供了一种有用且简单的标准。
