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目的:评估QRS-V_(HIS)和QRS-V_(RVA)间期在鉴别流出道室性早搏起源部位中的价值。方法:连续入选2016年6月—12月行导管射频消融治疗流出道室性早搏的16例患者,术中放置标测导管于希氏束(HIS)区域及右室心尖部(right ventricular apex,RVA),在电解剖标测系统和影像指引下行流出道多个部位起搏,同步记录体表12导联心电图、HIS和RVA腔内电图,分别测量QRS-V_(HIS)和QRS-V_(RVA)间期。结果:16例患者共获得139个起搏点,分为右室流出道(right ventricular outflow tract,RVOT)组94个和主动脉窦(aortic sinus cusp,ASC)组45个,RVOT组QRS-V_(HIS)间期显著大于ASC组[(42.98±14.83)ms vs.(19.66±16.14)ms,P<0.001],而两组QRS-V_(RVA)间期则无显著性差异。ROC曲线显示QRS-V_(HIS)间期的曲线下面积(AUC=0.860)显著大于QRS-V_(RVA)间期(AUC=0.626),QRS-V_(HIS)间期≤36.4 ms预测ASC起源的敏感性为67.1%、特异性为85.0%,QRS-V_(RVA)间期≥57.4 ms预测ASC起源的敏感性为54.3%、特异性为72.0%。结论 :QRS-V_(HIS)间期可作为一种鉴别流出道室性早搏起源的新方法。
Objective: To evaluate the value of QRS-V_ (HIS) and QRS-V_ (RVA) interval in identifying the origin of premature ventricular outflow tract premature beats. Methods: Sixteen consecutive patients undergoing RFA for effusion from ventricular premature beats were enrolled in June 2016 and December 2016. Surgical catheterization was performed on HIS and right ventricular apex RVA) were used to measure pacing of QRS-V_ (HIS) and QRS-V_ (RVA) in the echocardiography, (RVA) interval. Results: A total of 139 pacemaker points were obtained in 16 patients, which were divided into 94 RVOT (right ventricular outflow tract) groups and 45 aortic sinus cusp (ASC) groups. RVOT group QRS-V_ (HIS) was significantly longer than that in the ASC group [(42.98 ± 14.83) ms vs. (19.66 ± 16.14) ms, P <0.001]. There was no significant difference between the two groups in QRS-V_ (RVA) interval. The ROC curve showed that the area under the curve of QRS-V_ (HIS) interval (AUC = 0.860) was significantly greater than that of QRS-V_ (RVA) interval (AUC = 0.626) With a sensitivity of 67.1% and a specificity of 85.0%. The QRS-V_ (RVA) interval of ≥57.4 ms predicted the origin of ASC with a sensitivity of 54.3% and a specificity of 72.0%. Conclusion: QRS-V_ (HIS) interval can be used as a new method to identify the origin of premature ventricular effusion in outflow tract.