形态心电图标准对右心室流出道室性心律失常的鉴别价值

目的：探讨形态心电图标准对右心室流出道室性心律失常（VOT Vhs）的鉴别价值.方法：分析272例起源于右心室流出道（RVOT）并成功行导管射频消融治疗室性心律失常（VAs）患者的心电图资料,并与72例左心室流出道（LVOT） VAs患者进行比较,观察V1导联R波振幅比值＜0.3、时限比值＜0.5,v2导联R波振幅比值＜0.3、时限比值＜0.5,胸导联移行指数≥0,V2导联移行此＜0.6及胸导联移行≥V35种形态心电图标准对诊断RVOT VAs的敏感性、特异性、阳性预测值和阴性预测值,并进行ROC曲线分析.结果：①上述5种标准的敏感性分别为93.38％、91.18％、93.75％、71.69％、77.94％,特异性分别为87.50％、88.89％、91.67％、88.89％、93.06％,阳性预测值分别为96.58％、96.88％、97.70％、96.06％、97.70％,阴性预测值分别为77.78％、72.72％、79.52％、45.39％、52.76％.②5种诊断标准的ROC曲线下面积分别为0.904 （SE1：0.024,95％ CI：0.857 - 0.952）、0.900（SE2：0.024,95％ CI：0.854- 0.947）、0.927（SE3：0.021,95％ CI：0.887 - 0.968）、0.803（SE4：0.027,95％ CI：0.749-0.857）、0.855（SE5：0.023,95％ CI：0.809-0.901）.其中V1、V2导联R波时限比值＜0.5或振幅比值＜0.3,胸导联移行指数≥0分别与V2导联移行比＜0.6比较,以及胸前导联移行指数≥0与胸导联移行≥V3比较差异均有统计学意义（Z值分别为2.795、2.685、3.625、2.311,均P＜0.05）.其余各个标准之间比较差异均无统计学意义（P＞0.05）.结论：各种形态心电图标准对VOT VAs的鉴别均有一定的价值,其中V1、V2导联R波时限＜0.5或振幅比值＜0.3,胸导联移行指数≥0对鉴别RVOTVAs诊断具有相对的优势.

The value of electrocardiographic criteria in differential diagnosis of right ventricular outflow tract ventricular arrhythmias

Objective：To evaluate the value of electrocardiographic （ECG） criteria in differential diagnosis of right ventricular outflow tract ventricular arrhythmias （RVOT VAs）.Methods：The surface ECG pattern in 272 cases of right ventricular outflow tract VAs patients who underwent successful catheter ablation and compared with 72 cases of left ventricular outflow tract （LVOT） VAs patients were analyzed.Five criteria of the indexes of the R-wave amplitude＜0.3 and duration＜0.5,the precordial transitional zone index ≥ 0,the V2 transition ratio＜0.6 and precordial transition were observed ≥ V3 for diagnosing RVOT VAs and calculated their sensitivities,specificities,positive predictive values and negative predictive values.And recejver operating characteristic （ROC） curve analysis was conducted.Results：①The corresponding sensitivities were 93.38％,91.18％,93.75％,71.69％ and 77.94％,respectively,the corresponding specificities were 87.50％,88.89％,91.67％,88.89％ and 93.06％,respectively,the corresponding positive predictive values were 96.58％,96.88％,97.70％,96.06％ and 97.70％,respectively,the corresponding negative predictive values were 77.78％,72.72％,79.52％,45.39％ and 52.76％,respectively.②The areas under ROC curve according to different criteria were 0.904 （SE1：0.024,95％ CI：0.857-0.952）,0.900 （SE2：0.024,95％ CI：0.854-0.947）,0.927 （SE3：0.021,95％ CI：0.887-0.968）,0.803 （SE4：0.027,95％ CI：0.749-0.857）,0.855 （SE5：0.023,95％ CI：0.809-0.901）.There were significant differences found in the comparisons between the indexes of the r-wave amplitude＜0.3 and duration＜0.5 and the V2 transition ratio＜0.6,the precordial transitional zone index ≥ 0 and the V2 transition ratio＜0.6,the precordial transitional zone index ≥ 0 and precordial transition ≥ V3 （Z statistics were 2.795,2.685,3.625,2.311 respectively,all P＜0.05）.There were no significant differences found in the comparisons between the other criteria.Conclu