Study on the feasibility of distinguishing ventricular and pre-excited arrhythmia rhythms by a new algorithm

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2024-11-01 DOI:10.1016/j.jelectrocard.2024.153817

Honglin Ni , Qingcheng Wang , Zhiyong Wang , Wenbo Xu , Xiaowei Pan , Jianfang Zhu , Zhe Liu , Weixun Cai

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引用次数: 0

Abstract

Background

The differentiation and diagnosis of ventricular tachycardia (VT) and pre-excited tachycardia (PXT) remains a challenging task, especially when typical AV dissociation is not present. The purpose of this article is to study the feasibility of a new theoretical algorithm for identifying ventricular arrhythmias (VA) and pre-excited arrhythmias (PA) rhythms (which can be used to distinguish VT from PXT, etc.).

Method

This study involved the deduction of a new algorithm by combining knowledge of cardiac anatomy, vectorcardiography, and cardiac electrophysiology. The new algorithm evaluated the diagnostic value through intracardiac electrophysiology in 205 cases of VA and PA. The new algorithm diagnoses VA based on the following 4-step process:

1.
The QRS complex in leads II, III, and aVF shows a unidirectional R wave, and lead aVR shows a QS pattern.
2.
S waves are predominant in two or more of leads I, aVF, and V6.
3.
Lead V2 shows ≥3 phase waves or returning branch notching (note: returning branch refers to the band of QRS complexes returning to the baseline).
4.
Lead V5 shows a negative wave in the initial portion or returning branch notching.

If none of these criteria are met, the diagnosis is PA. The diagnostic value of the new algorithm is compared with the Steurer algorithm and the Vereckei algorithm (diagnosed based on the QRS waveform characteristics of the two algorithms during electrophysiological verification, excluding the diagnosis of atrioventricular dissociation).

Results

The new algorithm showed significant advantages in terms of AUC value (0.83 vs. 0.61 vs. 0.57), sensitivity (83.6 % vs. 23.3 % vs. 24.8 %), and accuracy (82.9 % vs. 48.3 % vs. 46.3 %) compared to the Steurer algorithm and Vereckei algorithm based on QRS waveform characteristics for diagnosing VA (137 cases) and PA (68 cases). This indicates that the new algorithm is more accurate in identifying idiopathic VA. While there was a significant difference in specificity between the New algorithm and Steurer algorithm (82.3 % vs. 98.5 %, p < 0.05), the difference with Vereckei algorithm (82.3 % vs. 89.7 %) was not significant.

In the New algorithm, the sensitivity and specificity for each step are as follows:

-
Step 1: Sensitivity 34.3 %, Specificity 94.1 %.
-
Step 2: Sensitivity 24.1 %, Specificity 98.5 %.
-
Step 3: Sensitivity 18.3 %, Specificity 100 %.
-
Step 4: Sensitivity 6.6 %, Specificity 89.7 %.

Step 1 had the highest AUC value, indicating the best overall diagnostic performance among all steps. Step 2 and Step 3 also performed well, while Step 4 had relatively poorer diagnostic performance.

Conclusion

The new algorithm is suitable for identifying the origin of VA and PA rhythms.

查看原文本刊更多论文

通过新算法区分室性和预激性心律失常节律的可行性研究

背景室性心动过速（VT）和预激性心动过速（PXT）的鉴别和诊断仍然是一项具有挑战性的任务，尤其是在不存在典型房室解离的情况下。本文旨在研究一种识别室性心律失常（VA）和预激性心律失常（PA）节律（可用于区分 VT 和 PXT 等）的新理论算法的可行性。新算法通过心内电生理学评估了 205 例 VA 和 PA 的诊断价值。新算法根据以下 4 个步骤诊断 VA：1.Ⅱ、Ⅲ 和 aVF 导联的 QRS 波群显示单向 R 波，aVR 导联显示 QS 模式。2.在 I、aVF 和 V6 导联中的两个或两个以上导联显示 S 波为主。3.V2 导联显示≥3 相波或回流支切迹（注：回流支指 QRS 波群返回基线的波段）。将新算法的诊断价值与 Steurer 算法和 Vereckei 算法（根据电生理验证时两种算法的 QRS 波形特征进行诊断，不包括房室解离的诊断）进行比较。结果在诊断 VA（137 例）和 PA（68 例）时，与基于 QRS 波形特征的 Steurer 算法和 Vereckei 算法相比，新算法在 AUC 值（0.83 vs. 0.61 vs. 0.57）、灵敏度（83.6 % vs. 23.3 % vs. 24.8 %）和准确度（82.9 % vs. 48.3 % vs. 46.3 %）方面均有显著优势。这表明新算法在识别特发性 VA 方面更为准确。在新算法中，每一步的灵敏度和特异度如下：第 1 步：灵敏度 34.第 2 步：灵敏度 24.1%，特异度 98.5%；第 3 步：灵敏度 18.3%，特异度 100%；第 4 步：灵敏度 6.6%，特异度 89.7%。结论：新算法适用于识别 VA 和 PA 节律的起源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.