实用心电与临床诊疗2025，Vol.34Issue(3)：342-347,6.DOI:10.13308/j.issn.2097-5716.2025.03.006
胸导联心电图特征对定位流出道室性早搏起源点的临床价值
Clinical value of chest lead electrocardiogram characteristics in locating origin of outflow tract premature ventricular contraction
摘要
Abstract
Objective By comparing the characteristics of chest lead electrocardiogram(ECG)indicators related to premature ventricular contraction(PVC),to explore the ECG indicators that can identify the origin point of outflow tract PVC more accurately.Methods Seventy-eight patients with outflow tract PVC who had received successful radiofrequency catheter ablation were retrospectively analyzed.Among them,52 cases of PVC were originated from the right ventricular outflow tract(RVOT),while 26 cases were originated from the left ventricular outflow tract(LVOT).The V2 transition index,SV2/RV3 index,RV1 wave duration index(RdV1/QRSdV1)and RV1/SV1 amplitude index were measured respectively.Each parameter and its diagnostic efficacy in differentiating outflow tract PVC were compared,and analyzed between the two groups.Results There were no statistically significant differences in clinical features including age,sex,body mass index,smoking history,drinking history,complicated hypertension,complicated diabetes,cardiac structural and functional parameters,preoperative ventricular arrhythmia burden by 24-hour ambulatory electrocardiography(AECG),and preoperative anti-arrhythmic drug types between the two groups(all P＞0.05).V2 transition index,SV2/RV3 index,RdV1/QRSdV1 and RV1/SV1 amplitude index were all significantly different between the two groups(all P＜0.01).ROC analysis and decision curve analysis(DCA)were used to explore the diagnostic performance of each parameter in distinguishing the origin of outflow tract PVC.The AUC value of V2 transition index was 0.837,its optimal cut-off value was 0.76,and the sensitivity,specificity and accuracy rate were separately 0.718,1.000 and 0.780.The AUC value of SV2/RV3 index was 0.859,its optimal cut-off value was 3.48,and the sensitivity,specificity and optimal accuracy rate were separately 0.718,1.000 and 0.780.The AUC value of RdV1/QRSdV1 was 0.741,its optimal cut-off value was 0.35,and the sensitivity,specificity and accuracy rate were separately 0.487,1.000 and 0.600.The AUC value of RV1/SV1 amplitude index was 0.836,its optimal cut-off value was 0.34,and the sensitivity,specificity and accuracy rate were separately 0.692,0.909 and 0.740.V2 transitional index and SV2/RV3 index had higher diagnostic predictive value.DCA results showed that SV2/RV3 index demonstrated the highest net benefit.Based on age,sex,body mass index,smoking and drinking history,hypertension,diabetes,cardiac structural and functional parameters,preoperative ventricular arrhythmia burden,and the use of preoperative anti-arrhythmic drugs,we constructed a basic model.After adding V2 transition index to it,the differentiation performance of the model was significantly improved(C-index was 0.924,95％ confidence interval:0.851-0.996,P=0.003);after adding SV2/RV3 index,its differentiation performance was further improved(C-index was 0.953,95％confidence interval:0.905-1.000,P＜0.001).Conclusion V2 transition index and SV2/RV3 index have relatively high differentiation value in locating the origin of outflow tract PVC,especially SV2/RV3 index demonstrating very high clinical utility value for PVC migrating in lead V2-V3.关键词
流出道室性早搏/SV2/RV3指数/射频导管消融/心电图Key words
outflow tract premature ventricular contraction/SV2/RV3 index/radiofrequency catheter ablation/electrocardiogram分类
医药卫生引用本文复制引用
赵波,张梦遥,冯振勤,杨昕宇,于宗良,唐枫燕..胸导联心电图特征对定位流出道室性早搏起源点的临床价值[J].实用心电与临床诊疗,2025,34(3):342-347,6.基金项目
国家自然科学基金资助项目(81700737) （81700737）
苏州市应用基础研究(医疗卫生)科技创新项目(SYWD2024191) （医疗卫生）
江苏大学临床医学科技发展基金项目(JLY20180109) （JLY20180109）
