三种判断流出道室性心律失常起源部位的心电图方法比较  

Differentiating left from right outflow tract ventricular arrhythmias ：comparison of 3 different electrocardiographic algorithms

作　　者：焦震宇[1] 李艳兵[1] 毛俊[1] 刘宵燕[2,3,4,5,6] 杨新春[1] 谭琛[7] 楚建民[2,3,4,5,6] 刘兴鹏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心, 100020 [2]中国医学科学院 [3]北京协和医学院 [4]国家心血管病中心 [5]心血管疾病国家重点实验室 [6]阜外心血管病医院心律失常中心 [7]北京军区总医院心内科

出　　处：《中华心律失常学杂志》2014年第6期420-424,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 比较3种判断流出道室性心律失常起源部位方法的准确性.方法 入选来自北京3家三甲医院2008年1月1日至2010年9月30日共110例（首都医科大学附属北京朝阳医院65例,阜外心血管病医院36例,北京军区总医院9例）成功消融的室性心律失常患者,标准12导联心电图均表现为左束支阻滞图形伴电轴下偏.3种心电图判断方法包括：①胸前导联移形区指数;②V2导联移形指数;③V2导联R波时限指数及R波振幅指数.结果 总体患者中,V2导联移形指数敏感性最高（92.3％）,V2导联R波时限指数及R波振幅指数特异性最高（93.9％）,并且其ROC曲线下面积最大（0.925）;心电图提示心脏转位的患者中,V2导联移形指数敏感性最高（94.1％）,V2导联R波时限指数及R波振幅指数特异性最高（87.5％）,V2移形指数ROC曲线下面积最大（0.892）.结论 3种方法中,V2移形指数敏感性最高,V2导联R波时限指数及R波振幅指数特异性最高.总体患者中,V2导联R波时限指数及R波振幅指数ROC曲线下面积最大;心电图提示心脏转位的患者中,V2移形指数ROC曲线下面积最大.Objective To evaluate which algorithms is the most accurate for differentiating the origins of outflow tract ventricular arrhythmia（OTVA）.Methods This study comprised 110 consecutive patients from 3 tertiary hospitals in Beijing（65 from Beijing ChaoYang hospital,36 from Beijing FuWai hospital,9 from Beijing military general hospital）,between January 1st 2008 and Suptember 30th 2010.Patients enrolled in this study with OTVA in whom the surface ECG showed typical left bundle branch block morphology with an inferior axis.All the ECG tracings were retrospectively analyzed using the following 3 ECG algorithms published recently：the transitional zone （TZ） index; the V2 transition ratio; V2 R-wave duration and R/S-wave amplitude indices.Results In all patients,the V2transition ratio had the highest sensitivity（92.3%）,while the R-wave duration and R/S-wave amplitude indices in V2 had the highest specificity（93.9%）.The latter showed the maximal area under the ROC curve（0.925）.In patients with precordail transition,the V2 transition ratio had the highest sensitivity（94.1%）,while the R-wave duration and R/S-wave amplitude indices in V2 had the highest specificity（87.5%）.The former showed the maximal area under the ROC curve（0.892）.Conclusion All 3 published ECG algorithms are effective in differentiating the origin of OTVA,while the V2 transition ratio is more sensitive and the V2 R-wave duration and R/S-wave amplitude indices is more specific.In all patients,the latter has the maximal area under the ROC curve,but in patients with rotation the former is the maximum.

关 键 词：室性早搏 室性心动过速 心电图 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]