Value of a Posterior Electrocardiographic Lead for Localization of Ventricular Outflow Tract Arrhythmias: The V4/V8 Ratio.
Value of a Posterior Electrocardiographic Lead for Localization of Ventricular Outflow Tract Arrhythmias: The V4/V8 Ratio.
复制标题
后心电图导联对心室流出道心律失常定位的价值：V4/V8 比值
DOI：
10.1016/j.jacep.2016.12.018
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发表时间：
2017-07-01
期刊：
影响因子：
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通讯作者：
Tung, Roderick
中科院分区：
文献类型：
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作者：
Zhang, Fengxiang;Hamon, David;Tung, Roderick
目的：本研究旨在前瞻性评估专用心电图后路导联的价值，该导联可以创建一个前后比来定位右心室流出道和左心室流出道之间的室性早搏（早搏），用于导管消融。背景：在室性心律失常的心电图定位中，左右流出道的前后关系尚未被探讨。方法：将标准V5和V6导联置于后侧，通过激活测绘进行消融。消融成功的部位与V4 r波与V8 r波的比值相关。通过将V4/V8比率除以鼻窦V4/V8来实现V4/V8比率归一化到V4/V8指数。在确定最佳截止点后，随后在前瞻性验证队列中使用受试者工作特征曲线与V2转换比和V2S/V3R进行比较。结果：共有134例患者接受了2根改良后导联的室性早搏消融。左侧室早消融成功后，其V4/V8比值明显高于右侧室早（11.7±10.6 vs. 2.3±2.4,p< 0.001）。在截断值为bbb3时，V4/V8比值对左侧病变的敏感性为88%，特异性为77%。在截断值为bb0 2.28时，V4/V8指数的敏感性为67%，特异性为98%。在前瞻性验证队列（n= 40）中，与V4/V8指数、V2过渡比和V2S/V3R相比，V4/V8比值的敏感性最高，为75%，阴性预测值为89%。V4/V8指数特异性最高，为96%，阳性预测值为89%。在分析V3转移病例时，V4/V8指数具有100%的特异性和阳性预测值。结论：简单的后置V5至V8可能为定位流出道发生的室性早搏提供增加的诊断价值。与其他有效的标准相比，将PVC定位标准标准化到窦性心律的结果是最高的特异性。
OBJECTIVES: This study sought to prospectively evaluate the value of a dedicated electrocardiographic posterior lead to create an anteroposterior ratio to localize premature ventricular complexes (PVCs) between the right ventricular outflow tract and left ventricular outflow tract for catheter ablation.BACKGROUND: The anteroposterior relationship between the right and left outflow tract has not been explored for electrocardiographic localization of ventricular arrhythmia.METHODS: Standard V5 and V6 leads were placed posteriorly and ablation was performed with activation mapping. The site of successful ablation was correlated with the ratio of the R-wave in V4 to the R-wave in V8. Normalization of the V4/V8 ratio to a V4/V8 index was achieved by dividing the V4/V8 ratio by sinus V4/V8. After determination of optimal cutoffs, comparison with V2 transition ratio and V2S/V3R was subsequently performed using receiver operating characteristic curves in a prospective validation cohort.RESULTS: A total of 134 patients underwent ablation of PVCs with 2 modified posterior leads. PVCs successfully ablated from the left side had a statistically significantly higher V4/V8 ratio compared with right-sided PVCs (11.7 ± 10.6 vs. 2.3±2.4, p< 0.001). At a cutoff of >3, the V4/V8 ratio had a sensitivity of 88% with a specificity of 77% for left-sided locations. At a cutoff of >2.28, the V4/V8 index had a sensitivity of 67% with a specificity of 98%. In the prospective validation cohort (n= 40), the V4/V8 ratio exhibited the highest sensitivity of 75% with a negative predictive value of 89% compared with the V4/V8 index, V2 transition ratio, and V2S/V3R. The V4/V8 index had the highest specificity of 96% with positive predictive value of 89% compared to the other predictive ratios. When analyzing cases with a V3 transition, the V4/V8 index demonstrated 100% specificity and positive predictive value.CONCLUSIONS: A simple modification of V5 to V8 posteriorly may provide incremental diagnostic value for localizing PVCs arising from the outflow tracts. Normalizing PVC localization criteria to the sinus rhythm results in the highest specificity when compared with other validated criteria.