白帆,刘启明,孙超,秦奋,李溢溪,罗昔金,刘娜,杨宇帆,周胜华

• 1:中南大学湘雅二医院心血管内科
• 2:中南大学湘雅医学院附属海口医院心血管内科

摘要(Abstract)：

目的探讨aVL导联结合V_1导联对鉴别主动脉窦(ASC)起源室性早搏的实用性。方法连续纳入2015年1月至2017年8月于中南大学湘雅二医院心血管内科住院,行导管射频消融术的特发性流出道室性早搏患者102例。比较起源于ASC与右心室流出道(RVOT)的室性早搏,其12导联体表心电图的QRS波振幅之间的差异。结果 (1)28例(27.5%)室性早搏起源于ASC,74例(72.5%)起源于RVOT。V_1导联R/S波振幅比和aVL导联S波振幅为Roc曲线下面积(AUC)最大的两个指标,AUC值及95%CI分别为0.894(0.824~0.964)和0.831(0.749~0.912),界值分别为0.25和0.80;ASC组V_1导联R/S波振幅比[(1.14±1.32)比(0.16±0.18),P<0.001]和aVL导联S波振幅[(0.99±0.36)mV比(0.56±0.26)mV,P<0.001]均显著高于RVOT组,差异均有统计学意义。(2)V_1导联R/S波振幅比>0.25诊断ASC起源室性早搏的敏感度、特异度及准确度分别为78.6%、85.1%和83.3%;aVL导联S波振幅>0.80 mV诊断ASC起源室性早搏的敏感度、特异度及准确度分别为67.9%、83.8%和79.4%。aVL导联S波振幅>0.80 mV联合V_1导联R/S波振幅比>0.25形成诊断ASC起源室性早搏的新方法,其敏感度、特异度及准确度分别为60.7%、93.2%和84.3%,特异度及准确度均明显提高。结论 aVL导联结合V_1导联可准确鉴别ASC起源的室性早搏。

关键词(KeyWords)： aVL导联;V_1导联;室性早搏;主动脉窦

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 白帆,刘启明,孙超,秦奋,李溢溪,罗昔金,刘娜,杨宇帆,周胜华

参考文献(References)：

• [1]陶海龙,龙德勇,张金盈,等.右室流出道室性早搏的三维电解剖标测和导管消融.郑州大学学报(医学版),2011,46(4):547-550.
• [2]鲁志兵,江洪.不同起源部位室性早搏的心电图特点及消融治疗.中国心脏起搏与心电生理杂志,2011,25(1):72-76.
• [3]Coggins DL,Lee RJ,Sweeney J,et al.Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin.J Am Coll Cardiol,1994,23(6):1333-1341.
• [4]Ebrille E,Chandra VM,Syed F,et al.Distinguishing ventricular arrhythmia originating from the right coronary cusp,peripulmonic valve area,and the right ventricular outfl ow tract:utility of lead I.J Cardiovasc Electrophysiol,2014,25(4):404-410.
• [5]Shenthar J,Rai MK.Preexcited tachycardia mimicking outfl ow tract ventricular tachycardia ablated from the left coronary cusp.J Cardiovasc Electrophysiol,2014,25(6):653-656.
• [6]Shimoike E,Ohnishi Y,Ueda N,et al.Radiofrequency catheter ablation of lef t ventricular outflow tract tachycardia f rom the coronary cusp:a new approach to the tachycardia focus.J Cardiovasc Electrophysiol,1999,10(7):1005-1009.
• [7]高振华,胡建强.右室流出道起源与主动脉窦起源室性早搏的分析.中国心血管病研究,2014,12(3):247-249.
• [8]Hutchinson MD,Garcia FC.An organized approach to the localization,mapping,and ablation of outflow tract ventricular arrhythmias.J Cardiovasc Electrophysiol,2013,24(10):1189-1197.
• [9]Ge B,Ji KT,Ye HG,et al.Electrocardiogram features of premature ventricular contractions/ventricular tachycardia originating from the left ventricular outflow tract and the treatment outcome of radiofrequency catheter ablation.BMC Cardiovasc Disord,2012,12:112.
• [10]Lin D,Ilkhanoff L,Gerstenfeld E,et al.Twelve-lead electrocardiographic characteristics of the aortic cusp region guided by intracardiac echocardiography and electroanatomic mapping.Heart Rhythm,2008,5(5):663-669.
• [11]陶海龙,张金盈,李凌,等.三维标测系统Carto指导下消融特发性室性心动过速.郑州大学学报(医学版),2010,45(4):575-579.
• [12]Ito S,Tada H,Naito S,et al.Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia.J Cardiovasc Electrophysiol,2003,14(12):1280-1286.
• [13]Ouyang F,Fotuhi P,Ho SY,et al.Repetitive monomorphic ventricular tachycardia originating f rom the aortic sinus cusp:electrocardiographic characterization for guiding catheter ablation.J Am Coll Cardiol,2002,39(3):500-508.
• [14]Gami AS,Noheria A,Lachman N,et al.Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist:a study of 603 hearts.J Interv Card Electrophysiol,2011,30(1):5-15.
• [15]Movsowitz C,Schwartzman D,Callans DJ,et al.Idiopathic right ventricular outfl ow tract tachycardia:narrowing the anatomic location for successful ablation.Am Heart J,1996,131(5):930-936.
• [16]Klein LS,Shih HT,Hackett FK,et al.Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease.Circulation,1992,85(5):1666-1674.
• [17]龙德勇,孙莉萍,王琎,等.三维超声引导下经房间隔穿刺消融左心室前乳头肌室性早搏.中国介入心脏病学杂志,2017,25(6)321-325.
• [18]Del Carpio Munoz F,Syed FF,Noheria A,et al.Characteristics of premature ventricular complexes as correlates of reduced left ventricular systolic function:study of the burden,duration,coupling interval,morphology and site of origin of PVCs.J Cardiovasc Electrophysiol,2011,22(7):791-798.
• [19]Yoshida N,Yamada T,Mcelderry HT,et al.A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin:the V2S/V3R index.J Cardiovasc Electrophysiol,2014,25(7):747-753.
• [20]Cheng Z,Cheng K,Deng H,et al.The R-wave defl ection interval in lead V3 combining with R-wave amplitude index in lead V1:A new surface ECG algorithm for distinguishing left from right ventricular outfl ow tract tachycardia origin in patients with transitional lead at V3.Int J Cardiol,2013,168(2):1342-1348
• [21]Tanner H,Hindricks G,Schirdewahn P,et a1.Outfl ow tract tachycardia with R/S transition in lead V3:Six different anatomic approaches for successful ablation.J Am Coll Cardiol,2005,45(3):418-423.
• [22]Betensky BP,Park RE,Marchlinski FE,et a1.The V(2)transition ratio:a new electrocardiographic criterion for distinguishing left from right ventricular outfl ow tract tachycardia origin.J Am Coll Cardiol,2011,57(22):2255-2262.
• [23]Yoshida N,Inden Y,Uchikawa T,et al.Novel transitional zone index allows more accurate differentiation between idiopathic right ventricular outfl ow tract and aortic sinus cusp ventricular arrhythmias.Heart Rhythm,2011,8(3):349-356.
• [24]Ouyang F,Mathew S,Wu S,et al.Ventricular arrhythmias arising from the left ventricular outfl ow tract below the aortic sinus cusps:mapping and catheter ablation via transseptal approach and electrocardiographic characteristics.Circ Arrhythm Electrophysiol,2014,7(3):445-455.
• [25]Kamakura S,Shimizu W,Matsuo K,et al.Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outfl ow tract by body surface ECG.Circulation,1998,98(15):1525-1533.
• [26]郭继鸿.右室流出道特发性室早、室速诊断的三部曲.临床心电学杂志,2014,23(1):63-70.
• [27]Dixit S,Gerstenfeld EP,Callans DJ,et al.Electrocardiographic patterns of superior right ventricular outflow tract tachycardias:distinguishing septal and f ree-wall sites of origin.J Cardiovasc Electrophysiol,2003,14(1):1-7.