Penela Diego, Falasconi Giulio, Carreño Jose Miguel, Soto-Iglesias David, Fernández-Armenta Juan, Acosta Juan, Martí-Almor Julio, Benito Begoña, Bellido Aldo, Chauca Alfredo, Scherer Claudia, Viveros Daniel, Alderete Jose, Silva Etelvino, Ordoñez Augusto, Francisco-Pascual Jaume, Rivas-Gandara Nuria, Meca-Santamaria Julia, Franco Paula, De Lucia Carmine, Ali Hussam, Cappato Riccardo, Cámara Oscar, Francia Pietro, Berruezo Antonio
Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain.
University of Barcelona, Campus Clínic, Barcelona, Spain.
J Interv Card Electrophysiol. 2023 Nov;66(8):1877-1888. doi: 10.1007/s10840-023-01507-x. Epub 2023 Feb 16.
To predict the outflow tract ventricular arrhythmias (OTVA) site of origin (SOO) before the ablation procedure has important practical implications. The present study sought to prospectively evaluate the accuracy of a clinical and electrocardiographic hybrid algorithm (HA) for the prediction of OTVAs-SOO, and at the same time to develop and to prospectively validate a new score with improved discriminatory capacity.
In this multicenter study, we prospectively enrolled consecutive patients referred for OTVA ablation (N = 202), and we divided them in a derivation sample and a validation cohort. Surface ECGs during OTVA were analyzed to compare previous published ECG-only criteria and to develop a new score.
In the derivation sample (N = 105), the correct prediction rate of HA and ECG-only criteria ranged from 74 to 89%. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3 precordial transition (V3PT) patients, and was incorporated to the novel weighted hybrid score (WHS). WHS correctly classified 99 (94.2%) patients, presenting 90% sensitivity and 96% specificity (AUC 0.97) in the entire population; WHS mantained a 87% sensitivity and 91% specificity (AUC 0.95) in patients with V3PT subgroup. The high discriminatory capacity was confirmed in the validation sample (N = 97): the WHS exhibited an AUC (0.93), and a WHS ≥ 2 allowed a correct prediction of LVOT origin in 87 (90.0%) cases, yielding a sensitivity of 87% and specificity of 90%; moreover, the V3PT subgroup showed an AUC of 0.92, and a punctuation ≥ 2 predicted an LVOT origin with a sensitivity of 94% and specificity of 78%.
The novel hybrid score has proved to accurately anticipate the OTVA's origin, even in those with a V3 precordial transition. A Weighted hybrid score. B Typical examples of the use of the weighted hybrid score. C ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the derivation cohort. D ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the V3 precordial transition OTVA subgroup.
在消融手术前预测流出道室性心律失常（OTVA）的起源部位具有重要的实际意义。本研究旨在前瞻性评估临床和心电图混合算法（HA）预测OTVA起源部位的准确性，同时开发并前瞻性验证一种具有更高鉴别能力的新评分系统。
在这项多中心研究中，我们前瞻性纳入了连续接受OTVA消融治疗的患者（N = 202），并将他们分为推导样本和验证队列。分析OTVA发作时的体表心电图，以比较先前公布的仅基于心电图的标准，并开发一种新的评分系统。
在推导样本（N = 105）中，HA和仅基于心电图的标准的正确预测率在74%至89%之间。V3导联的R波振幅是鉴别V3胸前导联过渡（V3PT）患者左心室流出道（LVOT）起源的最佳心电图参数，并被纳入新的加权混合评分（WHS）。WHS正确分类了99例（94.2%）患者，在总体人群中敏感性为90%，特异性为96%（曲线下面积[AUC]为0.97）；在V3PT亚组患者中，WHS的敏感性为87%，特异性为91%（AUC为0.95）。在验证样本（N = 97）中证实了其高鉴别能力：WHS的AUC为0.93，WHS≥2可正确预测87例（90.0%）LVOT起源病例，敏感性为87%，特异性为90%；此外，V3PT亚组的AUC为0.92，评分≥2预测LVOT起源的敏感性为94%，特异性为78%。
新的混合评分已被证明能够准确预测OTVA的起源，即使是在有V3胸前导联过渡的患者中。A加权混合评分。B加权混合评分使用的典型示例。C推导队列中WHS和先前心电图标准预测LVOT起源的ROC分析。D V3胸前导联过渡OTVA亚组中WHS和先前心电图标准预测LVOT起源的ROC分析。
