常规心电图、动态心电图及多导心电图对流出道室性早搏定位诊断价值比较  

Locating ventricular outflow tract tachycardia origin using conventional electrocardiogram,dynamic electrocardiogram and multi-lead electrocardiogram:a comparison study

作　　者：彭隆[1] 王嘉睿 刘金来[1] 李苏华[1] 罗艳婷[1] 谢旭晶[1] 董睿敏[1] 朱洁明[1] PENG Long;WANG Jia-rui;LIU Jin-lai;LI Su-hua;LUO Yan-ting;XIE Xu-jing;DONG Rui-min;ZHU Jie-ming(Department of Cardiovascular,The Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510630,Guangdong,China;不详)

机构地区：[1]中山大学附属第三医院心血管内科,广东广州510630 [2]中山大学附属第五医院心血管内科,广东珠海519099

出　　处：《广东医学》2020年第9期890-893,共4页Guangdong Medical Journal

基　　金：国家自然科学基金青年科学基金(8190021046);广东省医学科研基金指令性课题(C2019107);中山大学高校基本科研业务费-青年教师培育项目(19ykpy40)。

摘　　要：目的分析比较常规心电图(ECG)、动态心电图(Holter)和多导心电图(MLE)对流出道室性早搏(简称室早)的定位诊断价值有无差异。方法入选在心血管科行心内电生理检查和射频消融术的流出道室早患者71例。术前完成ECG、Holter和MLE采集,分析各导联室早QRS波的形态特征;并采用4种不同的方法(V2导联R波振幅指数和时限指数、胸导联移行区、SV2/RV3、V2移行指数)来分析、比较3种心电图对左、右室流出道室早定位诊断准确性的差异。结果I、V2、V3、V4导联室早QRS波的主波方向在3种心电图中差异有统计学意义(P=0.000、0.048、0.000、0.022);采用V2导联R波振幅指数和时限指数、V2移行指数两种方法定位左、右室流出道室早时,ECG、Holter和MLE的诊断准确性差异无统计学意义(P=0.881、0.768);而采用胸导联移行区、SV2/RV3两种方法定位左、右室流出道室早时,ECG和MLE的诊断准确性优于Holter(P=0.003、0.034)。结论ECG和MLE在判断流出道室早定位时优于Holter。Objective To analyze the diagnostic significances of conventional electrocardiogram(ECG),ambulatory electrocardiogram(Holter)and multi-electrocardiogram(MLE)in differentiating ventricular outflow tract tachycardia origin.Methods Seventy-one patients with ventricular outflow tract tachycardia who underwent intracardiac electrophysiological examination and radiofrequency ablation in our department from January 2017 to December 2018 were enrolled.ECG,Holter and MLE data were collected before operation,and the characteristics of QRS waves in each lead were analyzed.Four different methods,including V2 R wave amplitude index and time index,V2 transition ratio,chest lead transition zone index and SV2/RV3,were used to analyze and compare the differences in the accuracy of three ECG mapping for location of left and right ventricular outflow tract.Results The main wave directions of the early QRS waves in the lead chambers of I,V2,V3 and V4 were statistically different among the three electrocardiograms(P=0.000;P=0.048;P=0.000;P=0.022).There was no statistical difference in the diagnostic accuracies of ECG,Holter and MLE in the right ventricular outflow tract,according to V2 R wave amplitude index and time limit index,and the V2 transition index(P=0.881;P=0.768).When the chest lead transitional zone index and SV2/RV3 were used to distinguishing left from right ventricular outflow tract tachycardia origin,the diagnostic accuracies of ECG and MLE were significantly better than Holter(P=0.003;P=0.034).Conclusion ECG and MLE are superior to Holter in locating left or right ventricular outflow tract tachycardia origin.

关 键 词：常规心电图 动态心电图 多导心电图 流出道室性早搏 

分 类 号：R540.41[医药卫生—心血管疾病] R541.7[医药卫生—内科学]