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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2013年第3期

页码:

341-344

栏目:

临床研究

出版日期:

2013-06-25

文章信息/Info

Title:

Surface electrocardiogram analysis of 207 outflow tract premature ventricular contractions

作者:

李世倍; 梁延春; 王祖禄; 魏慧娜; 杨桂棠; 金志清; 韩雅玲

(沈阳军区总医院心内科，辽宁 沈阳 110016)

Author(s):

LI Shi bei;  LIANG Yan chun;  WANG Zu lu;  WEI Hui na;  YANG Gui tang;  JIN Zhi qing;  HAN Ya ling

(Department of Cardiology, General Hospital, Shenyang Military Area Command, Shenyang 110016, Liaoning, China )

关键词:

流出道; 心动过速; 室性; 期前收缩; 室性; R/S转换; 体表心电图定位

Keywords:

outflow tract;  ventricular tachycardia;  premature ventricular contractions;  R/S translation;  iocalized by surface electrocardiogram

分类号:

R541.71

DOI:

-

文献标识码:

A

摘要:

目的:分析特发性流出道室性期前收缩(室早，premature ventricular contractions，PVC)的体表心电图定位特征，进而指导射频导管消融。方法:回顾性分析连续207例接受射频消融治疗、术中经电生理检查和(或)心室造影，证实起源于左心室流出道(LVOT)或右室流出道(RVOT)室性心律失常(VAs)患者体表心电图特点，测量胸前导联R波、S波的振幅，分析胸前导联QRS波群R/S转换与起源部位的关系，R/S转换在V3导联时计算V2导联R/S振幅比值。结果:VAs时胸前导联R/S转换在V2或以前的VAs患者18(男8，女10)例，年龄23~87(44±17)岁，起源于LVOT 17例，特异性99%，敏感性68%。胸前导联R/S转换在V4或以后的共113(男43，女70)例，年龄4~73(42±14) 岁，均起源于RVOT，特异性100%，敏感性62%。胸前导联R/S转换在V3的VAs患者76（男25，女51）例，年龄17~82(46±13)岁；起源于RVOT 68例，起源于LVOT 8例，V2导联R/S值比分别为0.32±0.17 vs. 0.64±0.21（P<0.05）。结论:流出道室早胸前导联R/S转换早于V2和晚于V4分别提示起源于LVOT和RVOT的特异性和敏感性均较高。转换在V3时，起源于LVOT的VAs胸前V2导联的R/S比值明显高于起源于RVOT者。

Abstract:

AIM:To study the surface electrocardiogram characteristics of outflow tract ventricular arrhythmias as possible guidance for catheter ablation. METHODS: ECG characteristics in 207 consecutive patients who underwent radiofrequency catheter ablation of VT/PVCs originating from LVOT or RVOT were analyzed respectively. The amplitudes of R wave and S wave of precordial leads were measured. The relationship between the origin site and the precordial lead at which R/S translated was analyzed and R/S amplitude ratios were calculated. RESULTS: The number of patients whose transition of R/S on precordial leads was before lead V2, in lead V3 and after lead V4 were 18[aged (44±17) years], 76[aged (46±13) years]and 113[aged (42±14) years], respectively. In the 18 cases of R/S wave transition before lead V2, LVOT origin was defined in 17 patients, with the specificity of 99%, sensitivity of 68%, positive predictive value of 94% and negative predictive value of 96%. In the 113 cases of R/S transition after lead V4, RVOT origin was defined in all the patients, with the specificity of 100%, sensitivity of 62%, positive predictive value of 100% and negative predictive value of 26%. In the 76 cases of R/S wave transition in lead V3, RVOT and LVOT origin were defined in 68 patients and 8 patients respectively. The lead V2 R/S amplitude ratios from RVOT and LVOT were 0.32±0.17 vs. 0.64±0.21 (P<0.05) respectively. CONCLUSIONS: The specificity of identifying the origin of ventricular arrhythmias from LVOT by R/S transition before lead V2 is high, and so are the specificity and the sensitivity of identifying origin from RVOT by R/S transition after lead V4. In the cases of R/S wave transition in lead V3, R/S amplitude ratios of the VAs originating from LVOT are higher than those from RVOT.

参考文献/References

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备注/Memo

备注/Memo:

收稿日期：2013-01-22.
基金项目：国家自然科学基金项目资助（30670844）；辽宁省自然科学基金（22102250）
通讯作者：王祖禄，主任医师，主要从事心律失常的基础与临床研究 Email：wangzl@medmail.com.cn 共同通讯作者：梁延春，主任医师，主要从事心律失常的基础与临床研究 Email：liangyanchun@sina.com
作者简介：李世倍，主治医师，硕士 Email：13352456670@163.com

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更新日期/Last Update: 2013-07-16