A novel noninvasive surface ECG analysis using interlead QRS dispersion in arrhythmogenic right ventricular cardiomyopathy

作者：Hsieh Wan Hsin; Lin Chin Yu; Te Abigail Louise D; Lo Men Tzung; Wu Cheng I; Chung Fa Po; Chang Yi Chung; Chang Shih Lin; Lin Chen; Lo Li Wei; Hu Yu Feng; Liao Jo Nan; Chen Yun Yu; Jhuo Shih Jie; Raharjo Sunu Budhi; Lin Yenn Jiang; Chen Shih Ann

来源：PLos One, 2017, 12(8): e0182364.

DOI：10.1371/journal.pone.0182364

Background
This study investigated the feasibility of using the precordial surface ECG lead interlead QRS dispersion (IQRSD) in the identification of abnormal ventricular substrate in arrhythmogenic right ventricular cardiomyopathy (ARVC).
Methods
Seventy-one consecutive patients were enrolled and reclassified into 4 groups: definite ARVC with epicardial ablation (Group 1), ARVC with ventricular tachycardia (VT, Group 2), idiopathic right ventricular outflow tract VT without ARVC (Group 3), and controls without VT (Group 4). IQRSD was quantified by the angular difference between the reconstruction vectors obtained from the QRS-loop decomposition, based on a principal component analysis (PCA). Electroanatomic mapping and simulated ECGs were used to investigate the relationship between QRS dispersion and abnormal substrate.
Results
The percentage of the QRS loop area in the Group 1-2 was smaller than the controls (P = 0.01). The IQRSD between V1-V2 could differentiate all VTs from control (P<0.01). Group 1-2 had a greater IQRSD than the Group 3-4 (V4-V5, P = 0.001), and Group 1 had a greater IQRSD than Group 3-4 (V6-Lead I, P< 0.001). Both real and simulated data had a positive correlation between the maximal IQRSD (y= 0.62) and the extent of corresponding abnormal substrate (y= 0.71, both P< 0.001).
Conclusions
The IQRSD of the surface ECG precordial leads successfully differentiated ARVC from controls, and could be used as a noninvasive marker to identify the abnormal substrate and the status of ARVC patients who can benefit from epicardial ablation.

• 单位
  中央民族大学