Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York.
Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York.
Heart Rhythm. 2021 Nov;18(11):1959-1965. doi: 10.1016/j.hrthm.2021.08.003. Epub 2021 Aug 8.
Electrocardiographic (ECG) criteria have been proposed to localize the site of origin of outflow region ventricular arrhythmias (VAs). Many factors influence the QRS morphology of VAs and may limit the accuracy of these criteria.
The purpose of this study was to assess the accuracy of ECG criteria that differentiate right from left outflow region VAs and localize VAs within the aortic sinus of Valsalva (ASV).
One hundred one patients (mean age 52 ± 16 years; 55 [54%] women) undergoing catheter ablation of right ventricular outflow tract (RVOT) or ASV VAs with a left bundle branch block, inferior axis morphology were studied. ECG measurements including V transition ratio, transition zone index, R-wave duration index, R/S amplitude index, VS/VR index, V QRS morphology, R-wave amplitude in the inferior leads were tabulated for all VAs. Comparisons were made between the predicted site of origin using these criteria and the successful ablation site.
Patients had successful ablation of 71 RVOT and 38 ASV VAs. For the differentiation of RVOT from ASV VAs, the positive predictive values and negative predictive values for all tested ECG criteria ranged from 42% to 75% and from 71% to 82%, respectively, with the VS/VR index having the largest area under the curve of 0.852. Morphological QRS criteria in leads V through V did not localize ASV VAs. The maximum R-wave amplitude in the inferior leads was the sole criterion demonstrating a significant difference between right ASV, right-left ASV commissure, and left ASV sites.
ECG criteria for differentiating right from left ventricular outflow region VAs and for localizing ASV VAs have a limited accuracy.
心电图（ECG）标准已被提出用于定位流出区域室性心律失常（VA）的起源部位。许多因素影响VA 的 QRS 形态，可能限制这些标准的准确性。
本研究旨在评估区分右和左流出区域 VA 以及在主动脉窦内（ASV）定位 VA 的心电图标准的准确性。
研究了 101 例（平均年龄 52±16 岁；55[54%]名女性）接受右心室流出道（RVOT）或具有左束支传导阻滞、下侧轴形态的 ASV VA 导管消融的患者。记录所有 VA 的心电图测量值，包括 V 过渡比、过渡区指数、R 波持续时间指数、R/S 幅度指数、VS/VR 指数、V QRS 形态、下导联 R 波幅度。比较这些标准预测的起源部位与成功消融部位。
患者成功消融了 71 例 RVOT 和 38 例 ASV VA。对于 RVOT 与 ASV VA 的区分，所有测试 ECG 标准的阳性预测值和阴性预测值分别为 42%至 75%和 71%至 82%，VS/VR 指数的曲线下面积最大，为 0.852。V 至 V 导联的形态 QRS 标准不能定位 ASV VA。下导联的最大 R 波幅度是唯一在右 ASV、右-左 ASV 结合部和左 ASV 部位之间显示出显著差异的标准。
区分右和左心室流出区域 VA 以及定位 ASV VA 的心电图标准准确性有限。
