aVR与aVL导联QS波振幅比鉴别右室流出道室性心律失常起源前后侧的价值  

Value of electrocardiographic aVR/aVL QS-wave amplitude ratio in differentiat-ing posterior and anterior origins in right ventricular outflow tract ventricular arrhythmias

作　　者：张海青 张玉霄[1] 史成龙 周叶 卢才义[1] ZHANG Hai-Qing;ZHANG Yu-Xiao;SHI Cheng-Long;ZHOU Ye;LU Cai-Yi(Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China;Department of First Outpatient, No. 960 Hospital of Joint Logistic Support Force of PLA, Jinan 250031, China;Department of Cardiology, No. 983 Hospital of Joint Logistic Support Force of PLA, Tianjin 300142, China;Department of Cardiology, Center for Medical Health Care, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]解放军总医院第一医学中心心血管内科,北京100853 [2]解放军联勤保障部队第九六〇医院第一派驻门诊部,济南250031 [3]解放军联勤保障部队第九八三医院心血管内科,天津300142 [4]首都医科大学附属北京友谊医院医疗保健中心心血管内科,北京100050

出　　处：《中华老年多器官疾病杂志》2020年第4期297-300,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：联勤保障部队重大项目(AWS13C008)。

摘　　要：目的研究心电图aVR与aVL导联的QS波振幅比值鉴别右室流出道室性心律失常起源前后侧的意义。方法回顾性分析2009年至2019年在解放军总医院第一医学中心行导管射频消融的且靶点在右室流出道的室性心律失常患者87例的临床资料。根据术中右前斜30°X射线投射下的消融靶点位置,将手术患者划分为2组:前侧组(n=52)和后侧组(n=35)。测量2组患者室性心律失常发作时心电图的aVR与aVL导联QS波振幅,分析QS波振幅比值QSaVR/QSaVL与消融靶点位置前后的关系。采用SPSS 24.0软件进行统计分析。采用受试者工作特征(ROC)曲线计算QSaVR、QSaVL、QSaVR/QSaVL对RVOT起源点前后侧预测的灵敏度与特异度,采用曲线下面积(AUC)对比其准确性。结果QSaVR/QSaVL在右室流出道前侧显著小于后侧[(1.25±0.81)和(2.13±1.16),P<0.001]。ROC曲线结果显示,3个指标中QSaVR/QSaVL(0.786)的AUC大于QSaVL(0.724)和QSaVR(0.649);当QSaVR/QSaVL截断点取1.48时,约登指数最大(0.54),此时预测右室流出道前侧靶点的灵敏度为0.83,特异度为0.71。结论aVR/aVL导联QS波振幅比对于鉴别右室流出道室性早搏起源的前后侧有一定指导意义。Objective To investigate the value of aVR/aVL QS-wave amplitude ratio on electrocardiogram in differentiation between posterior and anterior origins in right ventricular outflow tract(RVOT)ventricular arrhythmias(VA).Methods Clinical data of 87 VA patients who underwent successful radiofrequency catheter ablation with the target site at the RVOT during 2009 and 2019 in the First Medical Center of Chinese PLA General Hospital were collected and retrospectively analyzed.According to the target site for ablation which was determined by projection of 30°right anterior oblique X-ray,the patients were divided into anterior group(left half of the RVOT,n=52)and posterior group(right half of the RVOT,n=35).The QS-wave amplitudes in lead aVL and aVR during an episode of VA were calculated in both groups,and the relationship of their ratio,QS/QS,with the target site for ablation was analyzed.SPSS statistics 24.0 was used for data analysis.Receiver operating characteristic(ROC)curve was employed to calculate the sensitivity and specificity of QS,QS,and QS/QS in prediction of the anterior or posterior origin in RVOT-VAs,and the area under curve(AUC)was used to compare their accuracy.Results The QS/QS was significantly smaller for anterior origins than posterior origins in RVOT-VAs[(1.25±0.81)vs(2.13±1.16),P<0.001].The AUC for the QS/QS was larger(0.786)than that for the QS(0.724)or the QS(0.649).With an optimal cut-off value of 1.48,a Youden index was the largest(0.54),and the sensitivity was 0.83,specificity 0.71 in prediction of an anterior origin.Conclusion The aVR/aVL QS ratio is of certain guiding significance in differentiation of anterior from posterior origins in RVOT-VAs.

关 键 词：右室流出道 室性心律失常 心电图 射频消融 

分 类 号：R540.4[医药卫生—心血管疾病]