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目的探讨体表心电图定位诊断对于判断室性早搏(premature ventricular contractions,PVCs)左、右心室起源的价值。方法随机选择66例射频消融成功的室性早搏患者,分析其中49例右心室起源和17例左心室起源的室早患者体表心电图V2导联QRS形态、胸前导联R波移行区、V1和V2导联R/S高度、胸前导联移行区指数(transitional zone index,TZ)的差异,确定体表心电图室性早搏胸前导联移行区指数在室性早搏起源定位中的敏感性和特异性。结果右心室起源的室性早搏V2导联多呈r S型、胸前导联R波多移行于V3-V5;左心室起源的室性早搏V2导联多呈Rs型、胸前导联R波多移行于V1-V2;右心室起源室性早搏V1、V2导联的R/S高度明显小于左心室起源的室性早搏(P<0.05),而TZ明显大于左室室早(P<0.05);TZ数值对于鉴别左、右心室起源的室性早搏的灵敏度、特异度、吻合度均较高(88.23%,83.67%,k=0.64)。结论体表心电图室性早搏的V2导联QRS形态、胸前导联R波移行区、V1和V2导联R/S高度、TZ,有助于鉴别室性早搏左、右心室的不同起源,TZ对于区分左、右心室起源的室性早搏有较好的诊断价值。
Objective To investigate the value of surface electrocardiogram (PECG) in the diagnosis of left ventricle and right ventricle in premature ventricular contractions (PVCs). Methods Sixty-six patients with premature ventricular premature beats who underwent radiofrequency catheter ablation were randomly selected. The QRS morphology of the lead ECG V2 lead, the R wave transitional region of the precordial lead, V1 And the V2 lead R / S height, chest lead transition zone index (TZ) of the difference, to determine the surface ECG of premature ventricular premature chest lead transition zone index in the preposition of ventricular premature beats in the sensitivity And specificity. Results Most of the premature ventricular contractions in the right ventricle were mostly rS-type and r-wave more than in V3-V5. The ventricular premature leads in the left ventricle were mostly Rs-type and R-type in the precordial leads (P <0.05), while TZ was significantly higher than that in the left ventricle (P <0.05), and the level of R / S in V1 and V2 leads was significantly lower than that in the left ventricle The sensitivity, specificity and good agreement of TZ values were higher for discriminating left ventricular premature ventricular contractions (88.23%, 83.67%, k = 0.64). Conclusions The QRS morphology of lead V2, the R wave transition zone of chest lead, the R / S height of lead V1 and V2, and TZ are helpful to identify the different origins of left and right ventricular premature ventricular contractions. TZ for the distinction between left and right ventricular premature ventricular contractions have a better diagnostic value.