V3转换流出道室性心律失常的体表心电图定位  

Origin of outflow tract ventricular arrhythmias with R/S transition in lead V3 localized by surface electrocardiogram

作　　者：李世倍[1] 梁延春[1] 王祖禄[1] 魏慧娜[1] 梁明[1] 杨桂棠[1] 金志清[1] 王璇[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心内科,沈阳医学硕士110016

出　　处：《医学研究生学报》2013年第10期1053-1055,共3页Journal of Medical Postgraduates

基　　金：国家自然科学基金(30670844);辽宁省自然科学基金(20102250)

摘　　要：目的通过体表心电图定位室性早搏起源已有不少报道,但关于R/S转换在V3导联的左右定位报道较少,文中报道V3转换的特发性流出道室性心律失常(ventriculararrhythmia,VA)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207例连续接受射频消融治疗、术中经电生理检查及心室造影证实起源于左心室流出道(left ventricle outflow tract,LVOT)或右心室流出道(right ventricle outflow tract,RVOT)患者体表心电图特点,胸前导联R/S转换在V3的VA患者75例,包括室性心动过速(ventricular tachycardia,VT)8例、特发性流出道频发室性早搏(premature ventricular contractions,PVCs)67例,均无器质性心脏病。结果 75例V3转换患者中,22例V2转换晚于窦性心律均起源于RVOT,VA时V2转换晚于窦性心律提示起源于RVOT的特异度、灵敏度、阳性预告值、阴性预告值分别为100%、32.35%、100%、13.21%。结论 V3转换的流出道VT/PVCs,V2转换晚于窦性心律时提示起源于RVOT的特异性与阳性预告值均高。Objective Few reports are seen on the origin of ventricular arrhythmia （VA） localized by surface electrocardiogram with the R/S transition in lead V3, through the electrocardiographic localization of the rough origin was reported abundantly. This study reports the characteristics of surface electrocardiogram in localizing idiopathic outflow tract VA with the R/S transition in lead V3 so as to provide a guide for radiofrequency catheter ablation. Methods We retrospectively analyzed the surface electrocardiographic characteristics of 207 VA patients undergoing continuous radiofrequency ablation, with the origin sites identified as the left ventricular outflow tract （LVOT） or right ventricular outflow tract （RVOT） by eleetrophysiologic study and ventriculography. Of the total number of cases, 75 had the R/S transition in lead V3, including 8 cases of ventricular tachycardia （VT） and 67 cases of premature ventricu lar contraction （ PVC）, none with organic heart disease. Results Of the 75 VA cases with the R/S transition in lead V3, 22 origi nated from RVOT with the R/S transition in lead V2 later than the sinus rhythm, which showed a specificity of 100% , a sensitivity of 32.35%, a positive predictive value of 100%, and a negative predictive value of 13.21%. Conclusion In outflow tract VT/PVC with the transition in lead V3, the R/S transition in lead V2 later than the sinus rhythm indicated a high specificity and a high positive predictive value of RVOT.

关 键 词：流出道 室性心动过速 室性早搏 V3转换 心电图定位 

分 类 号：R541.7[医药卫生—心血管疾病]