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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。
Objective To explore the method of electrocardiogram localization of ventricular arrhythmia in outflow tract of children with different origins. Methods Four kinds of electrocardiogram (V1 or V2 lead time-exponent and amplitude index, V2 migration index, transition zone index and V2S / V3R index) were applied to the First Affiliated Hospital of Tsinghua University from January 2009 to July 2015 Radiofrequency ablation of 94 cases of outflow ventricular arrhythmias in children with different ventricular arrhythmia origin of the site to be predicted and compared with intraoperative radiofrequency ablation results. Results The positive predictive value of four ECGs on the origin of ventricular arrhythmia in children with right ventricular outflow tract was 78.6% -88.2%, the sensitivity was 85.5% -91.3% and the specificity was 36.0% -68.0%. The left ventricular outflow tract The positive predictive value of ventricular arrhythmia was 47.4% -71.4%, sensitivity was 36.0% -68.0% and specificity was 85.5% -91.3%. The positive predictive value, sensitivity and specificity of ventricular arrhythmia in the origin of left coronary sinus were much higher than that of right ventricular sinuses (positive predictive value: 66.67% -90.90% vs.10.00% -15.38%; sensitive Degrees were 83.33% ~ 100.00% vs. 20.00% ~ 60.00%; specificity was 57.58% ~ 90.91% vs. 50.00% ~ 76.47%). Conclusions The positive predictive value of V2 migration index in four kinds of ECG algorithms has a good predictive value for ventricular arrhythmias in children with right ventricular outflow tract. Using the method of locating only the origins of the left and right ventricular outflow tract, the four ECGs have a lower predictive value of ventricular arrhythmia in children with the origin of left ventricular outflow tract. The left ventricular outflow tract is divided into left and right coronary sinus origin, the origin of left ventricular arrhythmias predicted levels significantly increased.