R_(Ⅲ)/S_(Ⅲ)比值预测邻近希氏束旁室性心律失常消融成功的价值  

The value of R/S ratio in leadⅢpredicts successful ablation of para-Hisian ventricular arrhythmias

作　　者：金琪琪 林佳选[1] 薛杨静 郑程[1] 李岳春[1] 李嘉[1] 曾刚焕 林加锋[1] Jin Qiqi;Lin Jiaxuan;Xue Yangjing;Zheng Cheng;Li Yuechun;Li Jia;Zeng Ganghuan;Lin Jiafeng(Department of Cardiology,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院心内科,温州325000

出　　处：《中华心律失常学杂志》2022年第5期473-479,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(82070333);浙江省温州市科技局重大科研项目(ZY2020018)。

摘　　要：目的探讨邻近希氏束旁室性心律失常(PH-VA)的心电图特征及Ⅲ导联R/S比值(R_(Ⅲ)/S_(Ⅲ))在预测消融成功和起源点距希氏束距离的价值。方法纳入2008年10月31日至2021年1月31日在温州医科大学附属第二医院经电生理检查与消融治疗符合PH-VA的患者根据胸部X线片及三维标测定位分为右侧PH-VA组和左侧PH-VA组:比较不同部位PH-VA的心电图特征及R_(Ⅲ)/S_(Ⅲ)比值在预测消融成功和起源点距希氏束距离的价值。结果224例患者纳入本研究,年龄(61.0±16.4)岁,男133例。消融成功199例(88.8%,199/224)。①右侧PH-VA组179例,年龄(61.5±15.8)岁,其中男106例;②左侧PH-VA组45例,年龄(59.4±15.2)岁,其中男27例。①若以V1导联呈R、QR、qR、qr、Qr、Qrs、qrS型及胸前导联移行<V1导联作为诊断左侧PH-VA的指标;以V1导联呈QS型作为鉴别右侧希氏束下与上方和左侧PH-VA的指标,均具有较高的敏感度、特异度及准确度;②Ⅲ导联以正、负向波为主的成功率分别为66.7%(44/66)及95.6%(151/158)(χ^(2)=34.51,P<0.001);③若以R_(Ⅲ)/S_(Ⅲ)比值≤1.1作为PH-VA消融成功的预测指标,以R_(Ⅲ)/S_(Ⅲ)比值>1.1作为PH-VA起源点距希氏束距离<5 mm的预测指标,均具有较高的敏感度、特异度及准确度。结论不同部位PH-VA的心电图特征不同,心电图指标对鉴别诊断有价值;R_(Ⅲ)/S_(Ⅲ)比值是PH-VA消融成功和起源点距希氏束距离<5 mm的有效预测指标。Objective To investigate the electrocardiographic characteristics of para-Hisian ventricular arrhythmias(PH-VA),and the value of R/S ratio in leadⅢ(R_(Ⅲ)/S_(Ⅲ))to predict the successful ablation of PH-VA and the distance from the site of origin of PH-VA to the site recording the largest His bundle potential.Methods Two hundred and twenty-four patients with PH-VA who underwent electrophysiological examination and catheter ablation in the Second Affiliated Hospital of Wenzhou Medical University from October 31,2008 to January 31,2021 were included in the study.According to X-ray image and three-dimensional mapping,the patients were divided into two subgroups.①Right PH-VA group:179 patients,man 106,average age(61.5±15.8)years.②Left PH-VA group:45 patients,man 27,average age(59.4±15.2)years.Electrocardiographic characteristics were analyzed in this 224 patients.Results One hundred and ninety-nine patients(88.8%,199/224)were successfully ablated.①The sensitivity,specificity and accuracy were high when V1 lead was R、QR、qR、qr、Qr、Qrs、qrS patterns or the precordial leads migration before V1 as the diagnostic indexes of left PH-VA,and when V1 lead was QS pattern as the diagnostic index to distinguish the VA originated below the right para-Hisian from the VA originated above the right para-Hisian and the left PH-VA.②The successful ablation rate of positive R wave and negative S wave in leadⅢwere 66.7%(44/66)and 95.6%(151/158)(χ^(2)=34.51,P<0.001).③The R_(Ⅲ)/S_(Ⅲ)ratio≤1.1 predicted the successful ablation of PH-VA and the R_(Ⅲ)/S_(Ⅲ)>1.1 predicted the distance<5 mm from the site of origin of PH-VA to the site recording the largest His bundle potential with high sensitivity,specificity and accuracy.Conclusion Electrocardiographic indexes has differential diagnostic value for PH-VA of different origins.The R_(Ⅲ)/S_(Ⅲ)ratio was a helpful predictor of the successful ablation of PH-VA and the distance<5 mm from the site of origin of PH-VA to the site recording the largest His bundle

关 键 词：室性早搏复合征 室性心律失常 室性心动过速 希氏束旁 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]