Abstract：
Previous studies have reported the presence of subtle abnormalities in the right ventricular outflow tract (RVOT) in patients with apparently normal hearts and ventricular arrhythmias (VAs) from the RVOT, including the presence of low voltage areas (LVAs). This LVAs seem to be associated with the presence of ST-segment elevation in V1 or V2 leads at the level of the 2nd intercostal space (ICS).
Our aim was to validate an electrocardiographic marker of LVAs in the RVOT in patients with idiopathic outflow tract VAs.
A total of 120 patients were studied, 84 patients referred for ablation of idiopathic VAs with an inferior axis by the same operator, and a control group of 36 patients without VAs. Structural heart disease including arrhythmogenic right ventricular cardiomyopathy was ruled out in all patients. An electrocardiogram was performed with V1-V2 at the 2nd ICS, and ST-segment elevation ≥1 mm and T-wave inversion beyond V1 were assessed. Bipolar voltage map of the RVOT was performed in sinus rhythm (0.5-1.5 mV color display). Areas with electrograms <1.5 mV were considered LVAs, and their presence was assessed. We compared three groups, VAs from the RVOT (n = 66), VAs from the LVOT (n = 18) and Control group (n = 36). ST-elevation, T-wave inversion and left versus right side of the VAs were tested as predictors of LVAs, respective odds ratio (ORs) (95% confidence interval [CI]) and p values, were calculated with univariate logist regression. Variables with a p < .005 were included in the multivariate analysis.
ST-segment elevation, T-wave inversion and LVAs were present in the RVOT group, LVOT group and Control group as follows: (62%, 17%, and 6%, p < .0001), (33%, 29%, and 0%, p = .001) and (62%, 25%, and 14%, p < .0001). The ST-segment elevation, T-wave inversion and right-sided VAs were all predictors of LVAs, respective unadjusted ORs (95% CI), p values were, 32.31 (11.33-92.13), p < .0001, 4.137 (1.615-10.60), p = .003 and 8.200 (3.309-20.32), p < .0001. After adjustment, the only independent predictor of LVAs was the ST-segment elevation, with an adjusted OR (95% CI) of 20.94 (6.787-64.61), p < .0001.
LVAs were frequently present in patients with idiopathic VAs. ST-segment elevation was the only independent predictor of their presence.
Our aim was to validate an electrocardiographic marker of LVAs in the RVOT in patients with idiopathic outflow tract VAs.
A total of 120 patients were studied, 84 patients referred for ablation of idiopathic VAs with an inferior axis by the same operator, and a control group of 36 patients without VAs. Structural heart disease including arrhythmogenic right ventricular cardiomyopathy was ruled out in all patients. An electrocardiogram was performed with V1-V2 at the 2nd ICS, and ST-segment elevation ≥1 mm and T-wave inversion beyond V1 were assessed. Bipolar voltage map of the RVOT was performed in sinus rhythm (0.5-1.5 mV color display). Areas with electrograms <1.5 mV were considered LVAs, and their presence was assessed. We compared three groups, VAs from the RVOT (n = 66), VAs from the LVOT (n = 18) and Control group (n = 36). ST-elevation, T-wave inversion and left versus right side of the VAs were tested as predictors of LVAs, respective odds ratio (ORs) (95% confidence interval [CI]) and p values, were calculated with univariate logist regression. Variables with a p < .005 were included in the multivariate analysis.
ST-segment elevation, T-wave inversion and LVAs were present in the RVOT group, LVOT group and Control group as follows: (62%, 17%, and 6%, p < .0001), (33%, 29%, and 0%, p = .001) and (62%, 25%, and 14%, p < .0001). The ST-segment elevation, T-wave inversion and right-sided VAs were all predictors of LVAs, respective unadjusted ORs (95% CI), p values were, 32.31 (11.33-92.13), p < .0001, 4.137 (1.615-10.60), p = .003 and 8.200 (3.309-20.32), p < .0001. After adjustment, the only independent predictor of LVAs was the ST-segment elevation, with an adjusted OR (95% CI) of 20.94 (6.787-64.61), p < .0001.
LVAs were frequently present in patients with idiopathic VAs. ST-segment elevation was the only independent predictor of their presence.
摘要：
先前的研究报道了右心室流出道（RVOT）中存在细微的异常，这些患者的心脏明显正常，室性心律失常（VAs）来自RVOT，包括低电压区域（LVAs）的存在。这种LVAs似乎与第二肋间空间（ICS）水平的V1或V2导线中ST段抬高的存在有关。
我们的目的是验证特发性流出道VAs患者RVOT中LVA的心电图标记。
共研究了120名患者，84例患者被同一操作者转诊为下轴特发性VAs消融，对照组36例患者无VAs。所有患者均排除了结构性心脏病，包括致心律失常性右心室心肌病。在第2次ICS用V1-V2进行心电图检查，评估了ST段抬高≥1mm和超过V1的T波倒置。在窦性心律下进行RVOT的双极电压图（0.5-1.5mV彩色显示）。电描记图<1.5mV的区域被认为是LVAs，并评估了他们的存在。我们比较了三组，来自RVOT的VA(n=66)，来自LVOT(n=18)和对照组(n=36)的VAs。ST段抬高,测试了T波反演和VAs的左右两侧作为LVAs的预测因子，各自的优势比(OR)(95%置信区间[CI])和p值，用单变量逻辑回归计算。P<.005的变量包括在多变量分析中。
ST段高程,RVOT组存在T波反转和LVAs，LVOT组和对照组如下：(62%，17%,6%,p<.0001),（33%，29%,0%,p=.001)和(62%，25%,14%,p<.0001)。ST段抬高,T波反演和右侧VAs都是LVAs的预测因子，各自未调整的OR（95%CI），p值是，32.31(11.33-92.13),p<.0001,4.137(1.615-10.60),p=.003和8.200（3.309-20.32），p<.0001。调整后,LVAs的唯一独立预测因子是ST段抬高，调整后的OR（95%CI）为20.94（6.787-64.61），p<.0001。
特发性VAs患者常出现LVA。ST段抬高是其存在的唯一独立预测因子。
我们的目的是验证特发性流出道VAs患者RVOT中LVA的心电图标记。
共研究了120名患者，84例患者被同一操作者转诊为下轴特发性VAs消融，对照组36例患者无VAs。所有患者均排除了结构性心脏病，包括致心律失常性右心室心肌病。在第2次ICS用V1-V2进行心电图检查，评估了ST段抬高≥1mm和超过V1的T波倒置。在窦性心律下进行RVOT的双极电压图（0.5-1.5mV彩色显示）。电描记图<1.5mV的区域被认为是LVAs，并评估了他们的存在。我们比较了三组，来自RVOT的VA(n=66)，来自LVOT(n=18)和对照组(n=36)的VAs。ST段抬高,测试了T波反演和VAs的左右两侧作为LVAs的预测因子，各自的优势比(OR)(95%置信区间[CI])和p值，用单变量逻辑回归计算。P<.005的变量包括在多变量分析中。
ST段高程,RVOT组存在T波反转和LVAs，LVOT组和对照组如下：(62%，17%,6%,p<.0001),（33%，29%,0%,p=.001)和(62%，25%,14%,p<.0001)。ST段抬高,T波反演和右侧VAs都是LVAs的预测因子，各自未调整的OR（95%CI），p值是，32.31(11.33-92.13),p<.0001,4.137(1.615-10.60),p=.003和8.200（3.309-20.32），p<.0001。调整后,LVAs的唯一独立预测因子是ST段抬高，调整后的OR（95%CI）为20.94（6.787-64.61），p<.0001。
特发性VAs患者常出现LVA。ST段抬高是其存在的唯一独立预测因子。
