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首页> 外文期刊>Heart rhythm: the official journal of the Heart Rhythm Society >Endocardial or epicardial ventricular tachycardia in nonischemic cardiomyopathy? the role of 12-lead ECG criteria in clinical practice
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Endocardial or epicardial ventricular tachycardia in nonischemic cardiomyopathy? the role of 12-lead ECG criteria in clinical practice

机译：非缺血性心肌病的心内膜或心外膜室性心动过速？ 12导联心电图标准在临床实践中的作用

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Background Specific 12-lead ECG criteria have been reported to predict an epicardial site of origin (SoO) of induced ventricular tachycardias (VTs) in left ventricular nonischemic cardiomyopathy. Objective The purpose of this study was to (1) determine the value of ECG criteria to predict an epicardial SoO of clinically documented VTs, (2) analyze the effect of VT cycle length (CL) and antiarrhythmic drugs on the accuracy of ECG criteria, and (3) assess interobserver variability. Methods In 36 consecutive patients with nonischemic left ventricular cardiomyopathy (age 58 ± 16 years, 75% male) who underwent combined endocardial/epicardial VT ablation, all clinically documented and induced right bundle branch block VTs were analyzed for previously reported ECG criteria to determine the SoO, as defined by ≥11/12 pace-map, concealed entrainment, and/or VT termination during ablation. Results In 21 patients with clinically documented (25 mm/s) right bundle branch block VT, none of the ECG criteria differentiated between patients with and those without an epicardial SoO. In induced VTs (100 mm/s), 2 of 4 interval criteria differentiated between an endocardial and epicardial SoO for slow VTs (CL >350 ms) and 2 of 4 criteria in patients on amiodarone, but none for fast VTs (CL ≤350 ms) or patients off amiodarone. The Q wave in lead I was the most accurate criterion for an epicardial SoO (sensitivity 88%, specificity 80%). In both clinically documented and induced VTs, interobserver agreement was poor for pseudodelta wave and moderate for other criteria. Conclusion When applied to clinically documented VTs, no ECG criterion could differentiate between patients with and those without an epicardial SoO. Published interval-based ECG criteria do not apply to fast VTs and patients off amiodarone.
机译：背景技术据报道，特定的12导联心电图标准可预测左心室非缺血性心肌病的诱发性室性心动过速（VT）的心外膜起源（SoO）。目的这项研究的目的是（1）确定ECG标准的价值，以预测临床记录的VT的心外膜SoO;（2）分析VT周期长度（CL）和抗心律失常药物对ECG标准准确性的影响， （3）评估观察者之间的变异性。方法对连续36例非缺血性左心室心肌病（年龄58±16岁，男性75％）接受心内膜/心外膜VT消融的患者，对所有临床记录和诱发的右束支传导阻滞VT进行分析，以评估先前报道的ECG标准，以确定SoO，由≥11/ 12的步速图，隐匿的夹带和/或消融期间的VT终止定义。结果在21例临床记录为（25 mm / s）右束支传导阻滞VT的患者中，没有ECG标准对有心外膜SoO的患者和没有心外膜SoO的患者进行区分。在诱发性室速（100 mm / s）中，对于慢速室速（CL> 350 ms），心内膜和心外膜SoO的4个间隔标准中的2个在胺碘酮患者中区分为4个标准中的2个，但对于快速室速（CL≤350毫秒）或停用胺碘酮的患者。导联I中的Q波是心外膜SoO的最准确判据（敏感性为88％，特异性为80％）。在临床记录的和诱发的室速中，对于假三角洲波，观察者间的一致性差，而对于其他标准，观察者间一致性差。结论当应用于临床记录的室速时，没有心电图标准可以区分有心外膜SoO的患者和没有心外膜SoO的患者。已发布的基于间隔的心电图标准不适用于快速室速和胺碘酮以外的患者。

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