Objective To investigate the utility of the electrocardiogram (ECG) for differentiating origins of outflow tract ventricular arrhythmias (OTVAs) in children.Methods From January 2009 to July 2015,94 children with OTVAs were involved in this study,who were managed by radiofrequency catheter ablation (RFCA).The 4 types of ECG algorithm [(1)V l/V2 R wave duration index and amplitude index;(2)V2 trausition ratio;(3)Transition zoue index;(4)V2S/V3R index]were used to predicting the origins of OTVAs and the accuracy of prediction was compared with the results of RFCA.Results The positive predictive rate of 4 kinds of ECG algorithm localizing the right ventricular outflow tract (RVOT)ventricular arrhythmia in children was 78.6％ ～ 88.2％,the sensitivity was 85.5％ ～ 91.3％,and the specificity was 36.0％ ～68.0％.The positive predictive rate of 4 kinds of ECG algorithm localizing the left ventricular outflow tract (LVOT) ventricular arrhythmia was 47.4％ ～ 71.4％,the sensitivity was 36.0％ ～68.0％,and the specificity was 85.5％ ～ 91.3％.The positive predictive rate of 4 kinds of ECG algorithm localizing the LVOT ventricular arrhythmia in children was 47.4％ ～ 71.4％,the sensitivity was 36.0％ ～ 68.0％,and the specificity was 85.5％ ～ 91.3％.However,the subgroup analysis showed that for OTVAs originating from LCC,the positive predictive value,sensitivity and specificity were much higher than RCC origin of ventricular arrhythmia (predictive value:66.67％ ～ 90.90％ vs.10.00％ ～ 15.38％;sensitivity:83.33％ ～ 100.00％ vs.20.00％ ～ 60.00％;specificity:57.58％ ～ 90.91％ vs.50％ ～ 76.47％).Conclusion However,the 4 kinds of ECG algorithm used in adults are limited to predict the LVOT ventricular arrhythmias in children.If LVOT origin group is divided into the LCC and RCC origingroups,the results show that in LCC group the prediction level increases significantly.%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.
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