胸前导联移行对右心室流出道室性心律失常的诊断价值
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摘要
目的:探讨胸导联移行对右心室流出道室性心律失常的诊断价值。方法:回顾性分析行导管射频消融术(金标准)治疗成功的295例起源于右心室流出道与77例起源于左心室流出道室性心律失常患者的心电图资料,观察左、右室流出道室早及右室流出道不同部位室早的胸导联移行情况,比较胸导联移行≥V3及胸导联移行指数≥0对诊断右心室流出道心律失常的敏感度、特异度、准确度、阳性预测值和阴性预测值,比较胸前导联移行≥V3对右室流出道不同部位室早的诊断敏感度。结果:左室流出道、右室流出道的移行分数及移行区指数分别为1.71±0.78、4.22±0.67、-1.48±1.31、0.56±0.72。胸前导联移行≥V3与胸导联移行指数≥0对诊断右心室流出道心律失常的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为76.95%、93.51%、80.38%、97.84%、51.43%及93.56%、90.91%、93.01%、97.53%、78.65%;右室流出道后间隔区、中间隔区、前间隔区、游离壁区的胸导联移行分数分别为3.65±0.82、3.76±0.54、4.53±0.65、4.75±0.66;胸导联移行≥V3对诊断右室流出道后间隔区、中间隔区、前间隔区、游离壁区的敏感度分别为56.52%、66.67%、89.11%、91.18%。结论:与左室流出道比,右室流出道室早胸导联移行比较晚,常在V3及之后导联出现。胸导联移行指数≥0提高鉴别的阳性率。对于右室流出道内位置靠前的游离壁区及前间隔壁此标准尤为适用。
Objective: To explore the diagnostic value of precordial transition in the ventricular arrhythmia of right ventricular outflow tract. Methods: Retrospectively study was made of ECG data from 295 patients with ventricular arrhythmias originating from the right ventricular outflow tract and 77 cases originating from left ventricular outflow tracts who were successfully treated with catheter radiofrequency ablation(gold standard).Precordial transition in the left and right ventricular outflow tracts and in different parts of the right ventricular outflow tract was observed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ventricular arrhythmia in the diagnosis of right ventricular outflow tract with the precordial transition ≥V3 were compared with the precordial transitional zone index ≥0 and a comparison was also made in diagnostic sensitivity of early ventricular outflow tract in different parts of the right ventricle with the Precordial transition ≥V3. Results: The migration score and transition zone index of the left ventricular outflow tract and right ventricular outflow tract were 1.71±0.78, 4.22±0.67,-1.48±1.31, 0.56±0.72 respecitively. The sensitivity,specificity, accuracy, positive predictive value, and negative predictive value of arrhythmia in the diagnosis of the right ventricular outflow tract with the precordial transition ≥V3 were 76.95%, 93.51%, 80.38%, 97.84%,51.43% respectively, and 93.56%, 90.91%, 93.01%, 97.53%, 78.65% in the precordial transitional zone index≥0. The thoracic leads in the posterior, medial, anterior, and free wall regions of the right ventricular outflow tract were 3.65±0.82, 3.76±0.54, 4.53±0.65, and 4.75±0.66, respectively. The sensitivity of the precordial transition ≥V3 to the diagnosis of the right posterior ventricular outflow tract in the posterior, middle, anterior, and free wall areas was 56.52%, 66.67%, 89.11%, and 91.18%, respectively. Conclusion: The precordial transition of the left ventricular outflow tract is more delayed than that of the right ventricular outflow tract and is often present in v3 and later leads. The precordial transitional zone index ≥0 improves the positive identification rate. It is particularly applicable to such standards as the free wall area and the front partition wall located in the front of the right ventricular outflow tract.
Objective: To explore the diagnostic value of precordial transition in the ventricular arrhythmia of right ventricular outflow tract. Methods: Retrospectively study was made of ECG data from 295 patients with ventricular arrhythmias originating from the right ventricular outflow tract and 77 cases originating from left ventricular outflow tracts who were successfully treated with catheter radiofrequency ablation(gold standard).Precordial transition in the left and right ventricular outflow tracts and in different parts of the right ventricular outflow tract was observed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ventricular arrhythmia in the diagnosis of right ventricular outflow tract with the precordial transition ≥V3 were compared with the precordial transitional zone index ≥0 and a comparison was also made in diagnostic sensitivity of early ventricular outflow tract in different parts of the right ventricle with the Precordial transition ≥V3. Results: The migration score and transition zone index of the left ventricular outflow tract and right ventricular outflow tract were 1.71±0.78, 4.22±0.67,-1.48±1.31, 0.56±0.72 respecitively. The sensitivity,specificity, accuracy, positive predictive value, and negative predictive value of arrhythmia in the diagnosis of the right ventricular outflow tract with the precordial transition ≥V3 were 76.95%, 93.51%, 80.38%, 97.84%,51.43% respectively, and 93.56%, 90.91%, 93.01%, 97.53%, 78.65% in the precordial transitional zone index≥0. The thoracic leads in the posterior, medial, anterior, and free wall regions of the right ventricular outflow tract were 3.65±0.82, 3.76±0.54, 4.53±0.65, and 4.75±0.66, respectively. The sensitivity of the precordial transition ≥V3 to the diagnosis of the right posterior ventricular outflow tract in the posterior, middle, anterior, and free wall areas was 56.52%, 66.67%, 89.11%, and 91.18%, respectively. Conclusion: The precordial transition of the left ventricular outflow tract is more delayed than that of the right ventricular outflow tract and is often present in v3 and later leads. The precordial transitional zone index ≥0 improves the positive identification rate. It is particularly applicable to such standards as the free wall area and the front partition wall located in the front of the right ventricular outflow tract.
引文
[1]RILLIG A, LIN T, OUYANG F F, et al. Which is the appropriate arrhythmia burden to offer RF ablation for RVOT tachycardia’s?[J]. J Atr Fibrillation, 2014, 7(4):41-49.
[2]MOTOKI K, KURITA T, YASUOKA R, et al. Simultaneous existence of sustained doublechamber tachycardias riginating from the aortic sinus of Valsalva[J]. J Cardiovasc Electrophysiol, 2012, 23(4):436-439.
[3]LAMBA J, REDFEARN D P, MICHAEL K A, et al. Radiofrequency catheter ablation for the treatment of idiopathicprematureventricularcontractionsoriginatingfromthe right ventricular outflow tract:a systematic review and meta-analysis[J]. PACE, 2014, 37(1):73-78.
[4]LING Z, LIU Z, SU L, et al. Radiofrequency ablation versusantiarrhythmicmedicationfortreatmentofventricular premature beats from the right ventricular outflow tract:prospective randomized study[J]. Cire Arrhythm Electrophysiol, 2014, 7(2):237-243.
[5]林加锋,林佳选,季亢挺,等.单导管射频消融治疗右心室心律失常的疗效与安全性[J].中华急诊医学杂志, 2008,17(12):1308-1313.
[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 cusp ventricular arrhythmias[J]. Heart Rhythm, 2011,8(3):349-356.
[7]KAMAKURA S, SHIMIZU W, MATSUO K, et al. Localizationofoptimalablationsiteofidiopathicventricular tachycardia from right and left ventricular outflow tract by body surface ecg[J]. Circulation, 1998, 98(15):1525-1533.
[8]ARYA A, HUO Y, FROGNER F, et al. Effect of limb lead electrodes location on ecg and localization of idiopathic outflow tract tachycardia:A prospective study[J]. J Cardiovasc Electrophysiol, 2011, 22(8):886-891.
[2]MOTOKI K, KURITA T, YASUOKA R, et al. Simultaneous existence of sustained doublechamber tachycardias riginating from the aortic sinus of Valsalva[J]. J Cardiovasc Electrophysiol, 2012, 23(4):436-439.
[3]LAMBA J, REDFEARN D P, MICHAEL K A, et al. Radiofrequency catheter ablation for the treatment of idiopathicprematureventricularcontractionsoriginatingfromthe right ventricular outflow tract:a systematic review and meta-analysis[J]. PACE, 2014, 37(1):73-78.
[4]LING Z, LIU Z, SU L, et al. Radiofrequency ablation versusantiarrhythmicmedicationfortreatmentofventricular premature beats from the right ventricular outflow tract:prospective randomized study[J]. Cire Arrhythm Electrophysiol, 2014, 7(2):237-243.
[5]林加锋,林佳选,季亢挺,等.单导管射频消融治疗右心室心律失常的疗效与安全性[J].中华急诊医学杂志, 2008,17(12):1308-1313.
[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 cusp ventricular arrhythmias[J]. Heart Rhythm, 2011,8(3):349-356.
[7]KAMAKURA S, SHIMIZU W, MATSUO K, et al. Localizationofoptimalablationsiteofidiopathicventricular tachycardia from right and left ventricular outflow tract by body surface ecg[J]. Circulation, 1998, 98(15):1525-1533.
[8]ARYA A, HUO Y, FROGNER F, et al. Effect of limb lead electrodes location on ecg and localization of idiopathic outflow tract tachycardia:A prospective study[J]. J Cardiovasc Electrophysiol, 2011, 22(8):886-891.