Parreira Leonor, Marinheiro Rita, Carmo Pedro, Chambel Duarte, Mesquita Dinis, Amador Pedro, Marques Lia, Mancelos Sofia, Reis Roberto Palma, Adragao Pedro
Cardiology Department, Luz Hospital Lisbon, Lisboa, Portugal.
Cardiology Department, Setubal Hospital Centre, Setubal, Portugal.
J Cardiovasc Electrophysiol. 2022 Nov;33(11):2322-2334. doi: 10.1111/jce.15654. Epub 2022 Aug 21.
Previous studies have reported the presence of subtle abnormalities in the right ventricular outflow tract (RVOT) in patients with apparently normal hearts and ventricular arrhythmias (VAs) from the RVOT, including the presence of low voltage areas (LVAs). This LVAs seem to be associated with the presence of ST-segment elevation in V1 or V2 leads at the level of the 2nd intercostal space (ICS).
Our aim was to validate an electrocardiographic marker of LVAs in the RVOT in patients with idiopathic outflow tract VAs.
A total of 120 patients were studied, 84 patients referred for ablation of idiopathic VAs with an inferior axis by the same operator, and a control group of 36 patients without VAs. Structural heart disease including arrhythmogenic right ventricular cardiomyopathy was ruled out in all patients. An electrocardiogram was performed with V1-V2 at the 2nd ICS, and ST-segment elevation ≥1 mm and T-wave inversion beyond V1 were assessed. Bipolar voltage map of the RVOT was performed in sinus rhythm (0.5-1.5 mV color display). Areas with electrograms <1.5 mV were considered LVAs, and their presence was assessed. We compared three groups, VAs from the RVOT (n = 66), VAs from the LVOT (n = 18) and Control group (n = 36). ST-elevation, T-wave inversion and left versus right side of the VAs were tested as predictors of LVAs, respective odds ratio (ORs) (95% confidence interval [CI]) and p values, were calculated with univariate logist regression. Variables with a p < .005 were included in the multivariate analysis.
ST-segment elevation, T-wave inversion and LVAs were present in the RVOT group, LVOT group and Control group as follows: (62%, 17%, and 6%, p < .0001), (33%, 29%, and 0%, p = .001) and (62%, 25%, and 14%, p < .0001). The ST-segment elevation, T-wave inversion and right-sided VAs were all predictors of LVAs, respective unadjusted ORs (95% CI), p values were, 32.31 (11.33-92.13), p < .0001, 4.137 (1.615-10.60), p = .003 and 8.200 (3.309-20.32), p < .0001. After adjustment, the only independent predictor of LVAs was the ST-segment elevation, with an adjusted OR (95% CI) of 20.94 (6.787-64.61), p < .0001.
LVAs were frequently present in patients with idiopathic VAs. ST-segment elevation was the only independent predictor of their presence.
既往研究报道，心脏看似正常但发生右心室流出道（RVOT）室性心律失常（VAs）的患者，其RVOT存在细微异常，包括低电压区（LVAs）。这些LVAs似乎与第2肋间（ICS）水平V1或V2导联ST段抬高有关。
我们的目的是验证特发性流出道VAs患者RVOT中LVAs的心电图标志物。
共研究了120例患者，其中84例由同一位操作者转诊进行特发性VAs下轴消融，36例无VAs的患者作为对照组。所有患者均排除结构性心脏病，包括致心律失常性右心室心肌病。在第2 ICS处记录V1-V2导联心电图，评估ST段抬高≥1 mm及V1导联以外的T波倒置情况。在窦性心律下（0.5-1.5 mV彩色显示）进行RVOT双极电压图检查。心电图<1.5 mV的区域被视为LVAs，并评估其存在情况。我们比较了三组，即RVOT来源的VAs（n = 66）、LVOT来源的VAs（n = 18）和对照组（n = 36）。将ST段抬高、T波倒置以及VAs的左右侧作为LVAs的预测指标，采用单因素逻辑回归计算各自的比值比（ORs）（95%置信区间[CI]）和p值。p < 0.005的变量纳入多因素分析。
RVOT组、LVOT组和对照组中ST段抬高、T波倒置和LVAs的情况如下：（62%、17%和6%，p < 0.0001）、（33%、29%和0%，p = 0.001）以及（62%、25%和14%，p < 0.0001）。ST段抬高、T波倒置和右侧VAs均为LVAs的预测指标，各自未调整的ORs（95% CI）、p值分别为：32.31（11.33-92.13），p < 0.0001；4.137（1.615-10.60），p = 0.003；8.200（3.309-20.32），p < 0.0001。调整后，LVAs的唯一独立预测指标是ST段抬高，调整后的OR（95% CI）为20.94（6.787-64.61），p < 0.0001。
特发性VAs患者中LVAs常见。ST段抬高是其存在的唯一独立预测指标。
