Background

Electrocardiographic (ECG) criteria have been proposed to localize the site of origin of outflow region ventricular arrhythmias (VAs). Many factors influence the QRS morphology of VAs and may limit the accuracy of these criteria.

Objective

The purpose of this study was to assess the accuracy of ECG criteria that differentiate right from left outflow region VAs and localize VAs within the aortic sinus of Valsalva (ASV).

Methods

One hundred one patients (mean age 52 ± 16 years; 55 [54%] women) undergoing catheter ablation of right ventricular outflow tract (RVOT) or ASV VAs with a left bundle branch block, inferior axis morphology were studied. ECG measurements including V₂ transition ratio, transition zone index, R-wave duration index, R/S amplitude index, V₂S/V₃R index, V_1–3 QRS morphology, R-wave amplitude in the inferior leads were tabulated for all VAs. Comparisons were made between the predicted site of origin using these criteria and the successful ablation site.

Results

Patients had successful ablation of 71 RVOT and 38 ASV VAs. For the differentiation of RVOT from ASV VAs, the positive predictive values and negative predictive values for all tested ECG criteria ranged from 42% to 75% and from 71% to 82%, respectively, with the V₂S/V₃R index having the largest area under the curve of 0.852. Morphological QRS criteria in leads V₁ through V₃ did not localize ASV VAs. The maximum R-wave amplitude in the inferior leads was the sole criterion demonstrating a significant difference between right ASV, right-left ASV commissure, and left ASV sites.

Conclusion

ECG criteria for differentiating right from left ventricular outflow region VAs and for localizing ASV VAs have a limited accuracy.

中文翻译：

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特发性流出区室性心律失常定位心电图标准的再评价

背景

已经提出了心电图 (ECG) 标准来定位流出区室性心律失常 (VAs) 的起源部位。许多因素影响 VA 的 QRS 形态，并可能限制这些标准的准确性。

客观的

本研究的目的是评估 ECG 标准的准确性，该标准区分右流出区 VA 和左流出区 VA 并将 VA 定位在 Valsalva 主动脉窦 (ASV) 内。

方法

研究了 101 名患者（平均年龄 52 ± 16 岁；55 名 [54%] 女性）接受右心室流出道 (RVOT) 或 ASV VAs 导管消融左束支传导阻滞，下轴形态。ECG 测量值包括 V ₂过渡比、过渡区指数、R 波持续时间指数、R/S 幅度指数、V ₂ S/V ₃ R 指数、V _1-3 QRS 形态、劣质导联中的 R 波幅度被制成表格适用于所有 VA。使用这些标准预测的起源部位和成功的消融部位之间进行了比较。

结果

患者成功消融了 71 例 RVOT 和 38 例 ASV VA。对于区分 RVOT 和 ASV VA，所有测试 ECG 标准的阳性预测值和阴性预测值分别在 42% 到 75% 和 71% 到 82% 之间，其中 V ₂ S/V ₃ R 指数具有曲线下的最大面积为 0.852。_{V 1}至 V ₃导联的形态 QRS 标准未定位 ASV VA。下导联的最大 R 波幅度是唯一的标准，表明右侧 ASV、左右 ASV 连合和左侧 ASV 部位之间存在显着差异。

结论

用于区分右心室流出区 VA 和左心室流出区 VA 和定位 ASV VA 的 ECG 标准具有有限的准确性。