运用右胸导联心电图鉴别流出道室性早搏的左右室起源  

The value of right precordial lead ECG in differentiating left from right ventricular origin in patients with outflow tract premature ventricular contraction

作　　者：陆振钧 陈灿曦 邓国法 杨希 贾月贞 徐健 程典 Lu Zhen-jun;Chen Can-xi;Deng Guo-fa;Yang Xi;Jia Yue-zhen;Xu Jian;Cheng Dian(Department of Internal Medicine, Xinghu Hospital of Suzhou Industrial Park, Suzhou Jiangsu 215000;Department of Cardiovascular Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu 210029, China)

机构地区：[1]苏州工业园区星湖医院内科,江苏苏州215000 [2]南京医科大学附属第一医院心血管内科,江苏南京210029

出　　处：《实用心电学杂志》2018年第6期397-400,共4页Journal of Practical Electrocardiology

基　　金：江苏省第五期"333工程"科研项目(BRA2017190)

摘　　要：目的评价右胸导联心电图鉴别流出道室性早搏(室早)起源部位的价值。方法选取连续行导管射频消融治疗的85例流出道室早患者,平均(46. 28±14. 70)岁,根据起源部位分为右室流出道(RVOT)组64例、左室流出道(LVOT)组21例。术前分别记录标准12导联及右胸导联(V_(3R)、V_(4R)、V_(5R))心电图。回顾性分析室早时右胸导联的R波、S波振幅以及R波振幅比率,建立一种基于右胸导联的心电图新算法。将术中成功消融的靶点定义为室早的起源部位。结果室早时,RVOT组V3R导联R波振幅比率明显小于LVOT组[(0. 26±0. 21)vs.(0. 77±0. 33),P <0. 001]; V3R导联R波振幅比率的曲线下面积(AUC) 0. 849大于V_(4R)导联R波振幅比率的AUC(0. 781)及V_(5R)导联R波振幅比率的AUC(0. 697)。V3R导联R波振幅比率以0. 41为界值,鉴别室早左右室起源的敏感性及特异性分别为81. 4%和83. 3%。结论术前右胸导联心电图能初步判定室早的左右室起源,有助于指导手术方式的制定。Objective To evaluate the value of right precordial lead ECG on distinguishing the origin of outflow tract premature ventricular contraction(PVC).Methods Eighty-five patients with outflow tract PVC at an average age of(46.28±14.70)years old were selected in our study who had successively undergone catheter radiofrequency ablation.According to the origin of PVC,they were divided into right ventricular outflow tract(RVOT)group with 64 cases and left ventricular outflow tract(LVOT)group with 21 cases.Standard 12-lead and right precordial lead(V3R,V4R,V5R)ECG were separately recorded before the ablation.Right precordial lead ECG indexes including R-and S-wave amplitudes,and R-wave amplitude ratio were retrospectively analyzed,and a novel electrocardiographic algorithm based on right precordial leads was developed.The successfully ablated target was defined as the origin site of PVC.Results In the occurrence of PVC,the R-wave amplitude ratio of lead V 3R in RVOT group was significantly lower than that in LVOT group[(0.26±0.21)vs.(0.77±0.33),P<0.001].The area under curve(AUC)of V 3R R-wave amplitude ratio was greater than that of V 4R and V 5R R-wave amplitude ratio(AUC=0.849,0.781 and 0.697,respectively).The critical value of V 3R R-wave amplitude ratio was 0.41 with a sensitivity of 81.4%and a specificity of 83.3%in differentiating left from right ventricular origin among PVC patients.Conclusion Right precordial lead ECG could initially determine the origin of PVC between LVOT and RVOT foci before procedure,which is helpful to develop the ablation strategies.

关 键 词：流出道室性早搏 右胸导联 心电图算法 起源部位 

分 类 号：R540.4[医药卫生—心血管疾病]