QRS-V_(HIS)和QRS-V_(RVA)间期在鉴别流出道室性早搏起源部位中的价值  

The value of QRS-V_(HIS) interval and QRS-V_(RVA) interval on differentiating the origin of outflow tract premature ventricular contractions

作　　者：夏玉东 程典 杨兵[1] 张凤祥[1] 陈红武[1] 居维竹[1] 杨刚[1] 顾凯[1] 郦明芳[1] 曹克将[1] 陈明龙[1] 

机构地区：[1]南京医科大学第一附属医院心内科,江苏南京210029 [2]南京中医药大学附属盐城市中医院心内科,江苏盐城224001

出　　处：《南京医科大学学报（自然科学版）》2017年第11期1406-1409,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81070158)

摘　　要：目的:评估QRS-V_(HIS)和QRS-V_(RVA)间期在鉴别流出道室性早搏起源部位中的价值。方法:连续入选2016年6月—12月行导管射频消融治疗流出道室性早搏的16例患者,术中放置标测导管于希氏束(HIS)区域及右室心尖部(right ventricular apex,RVA),在电解剖标测系统和影像指引下行流出道多个部位起搏,同步记录体表12导联心电图、HIS和RVA腔内电图,分别测量QRS-V_(HIS)和QRS-V_(RVA)间期。结果:16例患者共获得139个起搏点,分为右室流出道(right ventricular outflow tract,RVOT)组94个和主动脉窦(aortic sinus cusp,ASC)组45个,RVOT组QRS-V_(HIS)间期显著大于ASC组[(42.98±14.83)ms vs.(19.66±16.14)ms,P<0.001],而两组QRS-V_(RVA)间期则无显著性差异。ROC曲线显示QRS-V_(HIS)间期的曲线下面积(AUC=0.860)显著大于QRS-V_(RVA)间期(AUC=0.626),QRS-V_(HIS)间期≤36.4 ms预测ASC起源的敏感性为67.1%、特异性为85.0%,QRS-V_(RVA)间期≥57.4 ms预测ASC起源的敏感性为54.3%、特异性为72.0%。结论 :QRS-V_(HIS)间期可作为一种鉴别流出道室性早搏起源的新方法。Objective： To assess the value of QRS-VHIS interval and QRS-VRVA interval on differentiating the origin of outflow tract premature ventricular contractions. Methods： Sixteen consecutive patients underwent radiofrequency ablation were enrolled from June 2016 to December 2016. Two quadrupolar catheters were positioned at the region of His bundle and right ventricular apex （RVA）. With the guidance of the electroanatomic mapping system and fluoroscopy, pace mapping was conducted at different sites in the right ventricular outflow tract（RVOT） and aortic sinus cusp（ASC）. Standard 12-lead electrocardiograph（ECG） and intracardiac electrogram of HIS and RVA were recorded simultaneously. Meanwhile, the QRS-VHIS and QRS-VRVA intervals were measured respectively. Results： A total of 139 pacing sites were obtained from 16 patients, and were divided into the RVOT group （n=94） and the ASC group （n=45）. The QRS-VHIS interval in the ROVT group was significantly longer than that in the ASC group [（42.98±14.83） ms vs.（19.66 ± 16.14） ms, P〈0.001）]. However, there was no significant difference in QRS-VRvs interval between the two groups. Receiver operating charac- teristic （ROC） analysis showed that the QRS-VHIS interval exhibited a greater area under the curve （AUC） （0.860） than the QRS-VRvA interval （0.626）. The QRS-VHIS interval ≤36.4 ms predicted an ASC origin with a sensitivity of 67.1% and specificity of 85.0%. The QRS-VRVA interval ≥57.4 ms had a sensitivity of 54.3% and specificity of 72.0%. Conclusion： The QRS-VIS interval could be used as a new approach to differentiate the origin of outflow tract premature ventricular contractions.

关 键 词：流出道 室性早搏 起搏标测 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]