新方法鉴别流出道室性心律失常消融靶点的定位意义  

A new method for locating the ablation targets of ventricular outflow tract arrhythmias

作　　者：卓珊珊 蒋晨阳[1] Zhuo Shanshan;Jiang Chenyang(Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou310016, China;Department of Electrocardiogram, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, China)

机构地区：[1]浙江大学医学院附属邵逸夫医院心内科,杭州310016 [2]中国科学院大学宁波华美医院心电图室,315010

出　　处：《中华心律失常学杂志》2019年第4期330-335,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：宁波市医疗卫生品牌学科建设项目(PPXK2018-01).

摘　　要：目的回顾性研究消融成功的流出道室性心律失常的术中12导联心内电图特征,得出快速有效定位左右心室流出道的方法,以期术前有效判断靶点方位,减少手术时间.方法回顾性分析2016年6月至2018年4月在浙江大学医学院附属邵逸夫医院行射频消融治疗室性心律失常(包括室性早搏和室性心动过速)定位在流出道,且术中12导联心内电图特征,选取室性心律失常时V1导联呈rS或QS型,下壁导联主波向上心电图表现的患者,分成右心室流出道组(n=125)和左心室流出道组(n=32).测量并分析患者发生室性心律失常时的V2导联R波最大偏移指数(V2导联R波达峰时间/V2导联QRS时限)、V2导联R波振幅指数(V2导联R波振幅/V2导联S波振幅)、SV2/RV3指数(V2导联S波振幅/V3导联R波振幅)、移行导联S/R指数(胸前导联移行区的前1个导联S波振幅/移行区导联的R波振幅)、移行区指数(TZI).结果当V1导联呈rS或QS型流出道室性心律失常时,无论心脏有无转位,敏感性最高是V2导联R波最大偏移指数87.5%,而特异性最高是移行导联S/R指数88%,SV2/RV3指数敏感性高但特异性不如移行导联S/R指数,阳性预测值最高是移行导联S/R指数60.5%,阴性预测值最高SV2/RV3指数95.2%.结论移行导联S/R指数≤1.0提示左心室流出道室性心律失常可作为一项新的特异性高的指标.Objective To reviewthe characteristics ofintraoperative 12-lead intracardiac electrograms in successful ablation of ventricular arrhythmias originating from outflow tract,and to obtain a rapid and effectivemethod for locating left and right ventricular outflow tracts,in order to effectively determine the target orientation andreducetheoperation time.Methods Retrospedive analysis was performed on the figures of 125 patients successfully ablated on the site of right ventricular outflowtract (RVOT) and 32 cases originating from left ventricular outflow tract (LVOT),underwent ablation for premature ventricular contraction (PVC)or ventricular tachycardia (VT)in Sir Run Run Shaw Hospital between June,2016 and April,2018.The patients with ventricular arrhythmia whose V1 lead was rS or QS,and the main wave of inferior wall leads was upward eledrocardiographic manifestation were selected as the research objects.we measured and analyzed the Rwave amplitude and R-wave peak time (RWPT),R-wave maximum deflection index (MDI),R-wave amplitude index in lead V2,S-wave amplitude in lead V2 dMded by R-wave amplitude in lead V3 (SV2/RV3),S-wave amplitude in former lead of R-wave transition in precordial leaddivided by R-wave amplitude in transition in precordial lead (TS/R),transitional zone index (TZI).Results rS orQS type in lead V1,the T S/R had the highest specificity (88%) and the R-wave maximum deflection index in lead V2had the highest sensitivty(87.5%) whether the heart was transposed or not.The SV2/RV3 had a higher sensitivty but a lower specificity than TS/R index.Conclusion T S/R index ≤ 1.0,indicatingLVOTventricular arrhythmia could be used as a new high specificity index,and the R-wave maximum deflection index in lead V2 ≥ 0.3 indicated a high sensitivity of LVOT in outflow tract PVC/VT.

关 键 词：心电描记术 心律失常 心性 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]