儿童流出道室性心律失常起源部位心电图定位探讨

发布时间：2018-02-14 20:50

本文关键词： 儿童室性心律失常流出道心电图　出处：《中国实用儿科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨儿童不同起源部位流出道室性心律失常的心电图定位方法。方法应用4种心电图算法(V1或V2导联R波时限指数及振幅指数、V2移行指数、移行区指数、V2S/V3R指数)对2009年1月至2015年7月清华大学第一附属医院接受射频消融治疗的94例流出道室性心律失常儿童不同室性心律失常起源部位进行预判,并与术中射频消融结果对比。结果 4种心电图算法对儿童右室流出道室性心律失常起源的阳性预测值为78.6%~88.2%,敏感度为85.5%~91.3%,特异度为36.0%~68.0%;对左室流出道室性心律失常起源的阳性预测值为47.4%~71.4%,敏感度为36.0%~68.0%,特异度为85.5%~91.3%。对左冠窦起源室性心律失常阳性预测值、敏感度和特异度均远高于右冠窦起源的室性心律失常(阳性预测值:66.67%~90.90%vs.10.00%~15.38%;敏感度为83.33%~100.00%vs.20.00%~60.00%;特异度为57.58%~90.91%vs.50.00%~76.47%)。结论 4种心电图算法中V2移行指数阳性预测值对儿童右室流出道起源室性心律失常有较好的预测价值。采用仅区分左、右室流出道起源的定位方法,4种心电图算法对儿童左室流出道起源室性心律失常预测值较低。将左室流出道分为左冠窦和右冠窦起源,对左冠窦起源室性心律失常预测水平明显提高。
[Abstract]:Objective to investigate the electrocardiographic localization of ventricular arrhythmias in children with outflow tract at different origination sites. Methods four electrocardiographic algorithms were used to determine the R wave duration index and amplitude index of V _ 1 or V _ 2 leads. From January 2009 to July 2015, 94 patients with outflow tract ventricular arrhythmias received radiofrequency ablation (RFCA) in the first affiliated Hospital of Tsinghua University. The origin sites of different ventricular arrhythmias in children with outflow tract ventricular arrhythmias were predicted. Results the positive predictive value of the right ventricular outflow tract arrhythmia in children with four electrocardiographic algorithms was 78.6 and 88.2, the sensitivity was 85.5 and 91.3, the specificity was 36.0 and 68.0, and the left ventricular outflow tract ventricular arrhythmia was caused by the left ventricular outflow tract arrhythmia. The positive predictive value of the source was 47.4 and 71.4, the sensitivity was 36.0 and 68.0, the specificity was 85.5 and 91.3. The positive predictive value of ventricular arrhythmia originated from the left coronary sinus. The sensitivity and specificity were significantly higher than those of ventricular arrhythmias originating from the right coronary sinus (positive predictive value: 66.67), 90.90vs.10.00 and 15.38; the sensitivity was 83.33; the sensitivity was 100.00vs.20.00; the specificity was 57.58 / 90.91vs.50.0076.477.Conclusion the positive predictive value of V2 transition index in the four electrocardiographic algorithms is useful for the development of the right ventricular outflow tract in children. Source ventricular arrhythmias have good predictive value. Methods for locating the origin of the right ventricular outflow tract (RVO), four electrocardiographic algorithms were used to predict the origin of ventricular arrhythmias in children. The left ventricular outflow tract was divided into left coronary sinus and right coronary sinus. The prediction level of ventricular arrhythmias originated from left coronary sinus was significantly improved.
【作者单位】：清华大学第一附属医院心脏中心小儿科;
【基金】：首都医学发展科研基金(2014-1-4121) 伍舜德博士医学科学研究基金(202-400-00811)
【分类号】：R725.4

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