摘要
探讨移行区指数和V_2S/V_3R指数对流出道室性早搏(PVC)的定位诊断价值。回顾导管消融成功的流出道PVC 100例,分析左室流出道(LVOT)和右室流出道(RVOT)移行区积分指数及V_2S/V_3R指数特点及其敏感性与特异性。LVOT-PVC在V_2导联前移行占63.6%(21/33),V_2~V_3占33.3%(11/33);ROVT-PVC在V_3导联后移行占70.1%(47/67),V_2~V_3占14.9%(10/67);LOVT-PVC和ROVT-PVC移行区积分存在显著差异(P<0.01)。移行区积分指数<0 LVOT-PVC占81.8%(27/33),RVOT-PVC占26.9%(18/67),LOVT-PVC显著低于ROVT-PVC(P<0.01)。V_2S/V_3R指数<1.5 LVOT-PVC占75.6%(25/33),ROVT-PVC占89.6%(60/67),前者显著低于后者(P<0.01)。V_2S/V_3R指数截断值=2.17,敏感性83.6%,特异性为87.9%;移行区积分指数截断值=0.25,敏感性为91.0%,特异性为81.8%。移行区积分指数、V_2S/V_3R指数对流出道PVC定位诊断价值大,特别是V_2~V_3之间移行的流出道PVC。
To investigate the diagnostic value of the V_2S/V_3R index and the index on the positioning of premature ventricular circulation(PVC).100 cases of outflow tract PVC with successful catheter ablation were reviewed. The left ventricular outflow tract(LVOT) and right ventricular outflow tract(RVOT) transition zone integral index and V_2S/V_3R index characteristics and their sensitivity and specificity were analyzed.LVOT-PVC accounted for 63.6%(21/33) before V_2 lead, and V_3~V_3 accounted for 33.3%(11/33);ROVT-PVC accounted for 70.1%(47/67) after V_3 lead, and 14.9%(10/67) for V_2~V_3; there was a significant difference between LOVT-PVC and ROVT-PVC transition zone(P<0.01).The transition zone integral index<0 LVOT-PVC accounted for 81.8%(27/33), RVOT-PVC accounted for 26.9%(18/67), and LOVT-PVC was significantly lower than ROVT-PVC(P<0.01).V_2S/V_3R index<1.5 LVOT-PVC accounted for 75.6%(25/33), and ROVT-PVC accounted for 89.6%(60/67). The former was significantly lower than the latter(P<0.01).The V_2S/V_3R index cutoff value was 2.17, the sensitivity was 83.6%, the specificity was 87.9%; the transition zone integral index cutoff value was 0.25, the sensitivity was 91.0%, and the specificity was 81.8%.The transition index and V_2S/V_3R index have great value in the diagnosis of outflow channel PVC, especially the outflow channel PVC between V_2 and V_3.
引文
[1] 刘建国,许爱斌,石红玲,等.三维标测系统CARTO3指导下室性早搏射频消融[J].中国循证心血管医学杂志,2014,6(4):483-5.
[2] Aldhoon B,Wichterle D,Peichl P,et al.Outcomes of ventricular tachycardia ablation in patients with structural heart disease:the impact of electrical storm[J].PLoS One,2017,12(2):e0171830.
[3] Nogami A.Mapping and ablating ventricular premature contractions that trigger ventricular fibrillation:trigger elimination and substrate modification[J].J Cardiovasc Electrophysio,2015,26(1):110-5.
[4] Yamada T,Yoshida N,Doppalapuidi H,et al.Efficacy of an anatomical approach in radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left ventricular outflow tract[J].Circ Arrhythm Electrophysiol,2017,10(5):e004959.
[5] Heeger C H,Hayashi K,Kuck K H,et al.Catheter ablation of idiopathic ventricular arrhythmias arising from the cardiac outflow tracts—recent insights and techniques for the successful treatment of common and challenging cases[J].Circ J,2016,80(5):1073-86.
[6] Yoshida N,Inden Y,Uchikawa T,et al.Novel transitional zone index allows more accurate differentiation between idiopathic right ventricular outflow tract and aortic sinus cups ventricular arrhythmias[J].Heart Rhythm,2011,8(3):349-56.
[7] Yoshida N,Yamada T,Mcelderry H T,et al.A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin:the V2S/V3R index[J].J Cardiovasc Electrophysiol,2014,(7):747-53.
[8] 广东医学编辑部.灵敏度、特异度和约登指数[J].广东医学,2004,25(11):1353.
[9] Betensky B P,Park R E,Marchlinski F E,et al.The V(2) transition ratio:a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin[J].J Am Coll Cardiol,2011,57(22):2255-62.
[10] 蒋智善,范咏梅,肖春霞,起源于右室流出道间隔部特发性室性早搏心电图及心电向量图研究[J].实用心电图学杂志,2016,25(3):181-7.
[11] Cheng D,Ju W,Zhu L,et al.V3R/V7 Index:A novel electrocardiographic criterion for differentiating left from right ventricular outflow tract arrhythmias origins[J].Circ Arrhythm Electrophysiol,2018,11(11):e006243.