Kamakura S, Shimizu W, Matsuo K, Taguchi A, Suyama K, Kurita T, Aihara N, Ohe T, Shimomura K
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan
Circulation. 1998 Oct 13;98(15):1525-33. doi: 10.1161/01.cir.98.15.1525.
Idiopathic ventricular tachycardia (VT) is known to arise from the right ventricular (RV) and left ventricular outflow tracts (LVOT). However, reliable noninvasive methods to localize the optimum ablation site for VT have not been reported.
Body surface maps (BSM) and 12-lead ECGs were investigated in 35 VTs from the RVOT and 5 VTs from the LVOT in which the origin was confirmed during the ablation procedure. The RVOT was classified into 8 subdivisions with the use of a 3-dimensional anatomic relation: anterior (A) posterior (P), right (R) left (L), and superior (S) inferior (I). On the BSM, the following 3 indexes differentiated each location of the origin, with a diagnostic accuracy of 88% (A-P), 92% (R-L), and 77% (S-I): (1) the location of the minimum at the early-to-mid QRS (right, A; left, P), (2) the isopotential distribution in the left shoulder area after 30 ms of QRS (positive, R; negative, L), and (3) the downward moving time of the minimum at the early-to-mid QRS (>/=50 ms, S; <50 ms, I). On the 12-lead ECG, (1) the QRS duration (>140 ms, A; </=140 ms, P) and the R-wave pattern in leads II and III (RR' or Rr', A, R, P), (2) the QS wave amplitude in aVR and aVL (aVR>/=aVL, R; aVR<aVL, L), and (3) the r-wave amplitude in V1 and V2 (high, S; low, I) localized the origin with 80%, 86% (A-P), 80% (R-L), and 66% (S-I) accuracy. R/S>/=1 in lead V3 was an index suggesting the LVOT origin.
The origin or the optimum ablation site of idiopathic VT from RVOT and LVOT can be localized with the use of indexes obtained with a BSM or 12-lead ECG.
已知特发性室性心动过速（VT）起源于右心室（RV）和左心室流出道（LVOT）。然而，尚未有报道称有可靠的非侵入性方法来定位VT的最佳消融部位。
对35例起源于RVOT的VT和5例起源于LVOT的VT进行体表标测（BSM）和12导联心电图检查，这些VT的起源在消融过程中得到证实。利用三维解剖关系将RVOT分为8个亚区：前（A）、后（P）、右（R）、左（L）、上（S）、下（I）。在BSM上，以下3个指标可区分起源的各个位置，诊断准确率分别为88%（A-P）、92%（R-L）和77%（S-I）：（1）QRS波群早期至中期最小值的位置（右侧，A；左侧，P），（2）QRS波群30 ms后左肩区的等电位分布（正向，R；负向，L），（3）QRS波群早期至中期最小值的下移时间（≥50 ms，S；<50 ms，I）。在12导联心电图上，（1）QRS波群时限（>140 ms，A；≤140 ms）以及II和III导联的R波形态（RR′或Rr′，A、R、P），（2）aVR和aVL导联的QS波振幅（aVR≥aVL，R；aVR<aVL，L），（3）V1和V2导联的r波振幅（高，S；低，I）定位起源的准确率分别为80%、86%（A-P）、80%（R-L）和66%（S-I）。V3导联R/S≥1是提示LVOT起源的指标。
利用BSM或十二导联心电图获得的指标可定位RVOT和LVOT特发性VT的起源或最佳消融部位。
