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目的 :评价 12导联心电图在鉴别左室和右室流出道室性心动过速 (VT)及鉴别左室流出道VT中主动脉瓣上起源的VT和主动脉瓣下起源的VT中的价值。方法 :回顾性分析了射频消融术获得成功的 5 6例流出道特发性VT患者体表心电图特点 ,右室流出道VT组 (RVOT VT)组 4 0例 ,左室流出道VT(LVOT VT)组 16例 ,其中主动脉瓣上组 (左冠窦内 ) 10例 ,主动脉瓣下组 6例。结果 :LVOT VT组胸前导联R波移行均早于V4导联 ,87.5 %(14 / 16 )在V1或V2 导联 ,RVOT VT组 82 .5 % (33/ 4 0 )胸前导联R波移行≥V4导联 ,无一例在V3 导联前移行 ;RVOT VT组V1和V2 导联R波时限指数和R/S波幅指数明显小于LVOT VT组 [(30 .4± 12 .6 ) %∶(5 7.4± 14 .2 ) %和 (13.8± 7.5 ) %∶(5 8.2± 11.4 ) % ,均P <0 .0 1]。主动脉瓣上LVOT VT组下壁导联 (Ⅱ ,Ⅲ ,aVF)R波振幅明显高于主动脉瓣下组 ;V5和V6导联或单独V6导联有s波对确定主动脉瓣下起源的LVOT VT敏感性 10 0 % (6 / 6 ) ,V5和V6导联均无s波对确定主动脉瓣上起源的LVOT VT特异性 90 % (9/ 10 )。结论 :体表心电图对初步确定心室流出道VT的起源部位可以提供很大的帮助。
PURPOSE: To evaluate the value of 12-lead electrocardiography in identifying ventricular tachycardia (VT) in the left and right ventricular outflow tract and in identifying VT originating in the aortic valve and VT originating in the aortic valve in left ventricular outflow tract VT . Methods: The electrocardiographic features of 56 patients with idiopathic VT of outflow tract were retrospectively analyzed. Forty patients with right ventricular outflow tract VT group (RVOT VT) and LVOT VT ) Group of 16 cases, including aortic valve group (left sinus within 10 cases), aortic valve group 6 cases. Results: The R wave shift in the chest lead of LVOT VT group was earlier than that of V4 lead, 87.5% (14/16) in V1 or V2 lead and 82.5% (33/40) in RVOT VT. R wave migration ≥V4 lead, none of the lead in the V3 lead migration; RVOT VT V1 and V2 leads R wave duration index and R / S amplitude index was significantly lower than the LVOT VT group [(30.4 ± 12.6) %: (5 7.4 ± 14.2)% and (13.8 ± 7.5)%: (5 8.2 ± 11.4)%, all P <0.01. The amplitude of R wave in inferior leads (Ⅱ, Ⅲ, aVF) of LVOT VT group was significantly higher than that of aortic valve group. S wave of V5 and V6 leads or V6 lead alone was used to determine the origin of aortic valve Of LVOT VT sensitivities were 10% (6/6), and none of the V5 and V6 leads had s-wave specificity of 90% (9/10) of the specificity for identifying LVOT VT originating from the aortic valve. Conclusion: Body surface electrocardiography can help to determine the origin of VT in ventricular outflow tract.