窄QRS波群室上性心动过速时ST-T改变的临床意义

目的观察ST-T改变对窄QRS波群房室折返性心动过速(AVRT)与房室结折返性心动过速(AVNRT)的鉴别诊断及旁道初步定位的作用。方法分析150例窄QRS波群心动过速患者发作时ST段压低程度及持续时间、T波倒置等情况。结果诊断为AVNRT55例,AVRT95例。ST段压低≥2mm且持续≥100ms者AVRT组(51例,53.68%)多于AVNRT组(15例,27.27%),ST段压低幅度AVRT组(1.58±1.35mm)大于AVNRT组(0.71±0.67mm),心房间传导时间AVRT组(81.02±32.47ms)长于AVNRT组(33.30±13.56ms),差异均有显著性意义(P均<0.05)。ST段压低导联分布左侧游离壁旁道者多见于V3～V6,左后间隔和右后间隔者多见于Ⅱ、Ⅲ、aVF,右侧游离壁旁道者无特异性。结论窄QRS波群室上性心动过速时ST段改变可作为区分AVRT与AVNRT的指标,且有初步旁道定位价值。     

Interesting case of narrow QRS tachycardia with atrioventricular dissociation

A 30-year-old man with no structural heart disease has been evaluated for paroxysmal palpitation with documented regular narrow QRS tachycardia that has not responded to intravenous adenosine. Surface electrocardiogram has not shown any pre-excitation. He has been taken for an electrophysiology study after informed consent. Diagnostic catheters were placed at the coronary sinus, His bundle region, and right ventricle. During catheter manipulation a regular narrow QRS tachycardia with incomplete right bundle branch block morphology and normal QRS axis similar to the clinical tachycardia got induced. No other tachycardia was induced. What is the mechanism of tachycardia?     

aVR新流程对宽QRS波群心动过速的鉴别诊断价值探讨

目的 探讨用单一aVR导联QRS波群形态变化对宽QRS波群心动过速的鉴别诊断价值.方法 106例宽QRS波群心动过速患者,用aVR4步流程鉴别诊断宽QRS波心动过速与临床诊断(病史+心电图演变+药物治疗观察)对照比较.结果 按aVR流程诊断为室上性心动过速32例,占30.18％,临床诊断室上性心动过速34例,占32.0...     

Pseudo P waves: a cause of diagnostic confusion in wide QRS tachycardia

A patient with wide QRS tachycardia is described. His initial electrocardiogram revealed P waves in lead V1 that led to a diagnosis of supraventricular tachycardia. Subsequently, during an electrophysiology study, the tachycardia was reproduced and documented to be ventricular in origin. The P waves seen were actually part of the QRS complex and therefore pseudo P waves. The correct diagnosis of the arrhythmia allowed for more appropriate therapy for the patient. This case illustrates that pseudo P waves may be present on the surface electrocardiogram and confuse the diagnosis of wide QRS tachycardia.     

心电图QRS波群复合振幅正常标准

为探讨国人不同年龄和性别心电图QRS波群复合振幅正常范围,计算4322例正常人群各年龄组QRS波群复合振幅(?)±s及百分位数值.结果显示:新生儿期QRS波群复合振幅一般都表现为女性>男性,儿童及成人则为男性>女性,青春期及青年男女振幅不同尤为显著.由于QRS波群振幅数据分布呈轻度正偏态,导致95%区间上限值的P_(97.5)位数值>(?)±1.96s值.研究表明:QRS波群复合振幅有显著的年龄和性别差异,且与国内参用的欧美标准值亦有差别,故临床诊断应分别采用男女标准值,参考欧美标准时应有条件地选择性使用.     

头胸导联心电图在窄QRS波心动过速鉴别诊断中的作用

目的观察在窄QRS波心动过速鉴别诊断时,头胸导联心电图是否优于常规12导联心电图。方法当患者发生窄QRS波心动过速时,同时记录常规心电图及头胸导联心电图各1份,由两位资深的电生理医生进行分析,作出心动过速机制的诊断。此后由观察者将两位医生分析两种体表心电图的结果与心内电生理检查的结果对照,计算出两种体表心电图诊断心动过速机制的准确率,并作卡方检验进行比较。结果41例患者入选本试验。第一位医生分析常规心电图的诊断准确率是80.5%(33/41),头胸导联心电图的准确率是90.2%(37/41);第二位医生分析常规心电图的诊断准确率是75.6%(31/41),头胸导联心电图的准确率是87.8%(36/41)。两位医生分析常规心电图的总体准确率是78.0%,头胸导联心电图的总体准确率是89.0%。两位医生在分析两种体表心电图的诊断准确率方面均无统计学差异(均为p>0.05)。结论在对窄QRS波心动过速鉴别诊断方面,头胸导联心电图似有比常规心电图更准确的趋势,但未显示出统计学差异。     

Sinus rhythm QRS amplitude and fractionation in patients with nonischemic cardiomyopathy to identify ventricular tachycardia substrate and location

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Wide QRS complex supraventricular tachycardia with negative precordial concordance: Electrocardiographic clues for Mahaim pathway with Ebstein anomaly

Ebstein's anomaly is often accompanied by either Wolff-Parkinson-White syndrome or atriofascicular Mahaim. These bypass tracts give rise to antidromic atrioventricular (AV) re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the AV node as the retrograde limb of the reentrant circuit. Since the antidromic AV reentrant tachycardia over a Mahaim fibre has a typically left bundle braunch block (LBBB) morphology, it is easy to make a misdiagnosis of supraventricular tachycardia with functional LBBB or even of ventricular tachycardia particularly in the presence of negative concordance. Some electrocardiographic clues might prevent misdiagnosis of ventricular tachycardia and inadvertent ICD implantation.     

胸前导联最大QRS波振幅诊断左室肥厚的研究

目的通过验证如下两项基本假设提出心电图(ECC)诊断左室肥厚(LVH)的新指标:①胸导联最大QRS振幅(Vmax)应该比某一特定导联的R或S波能更好地反映左室心肌重量(LVM);②体重/身高比值(WT/HT)可近似地代替左室中心到胸壁距离的平方而用以校正胸导联QRS振幅。方法将76例高血压患者常规12导联心电图与M型超声心动图左室心肌重量(LVM)及左室心肌重量指数(LVMI)进行分析比较。结果Vmax是与心室重量指数(LVMI)相关最密切的心电图指标(r=0.545,p<0.001)。Vmax乘以WT/HT后,与心室重量指数(LVMI)的相关系数由r=0.442提高到r=0.659(p<0.05)。结论①胸导联最大QRS振幅可能取代常规的电压指标,作为心电图左室肥厚的诊断新指标;②Vmax乘以WT/HT可进一步提高其诊断效能。     

宽QRS波心动过速的鉴别诊断及治疗研究进展

宽QRS波心动过速是临床常见的心血管急症,可见于室性心动过速和部分室上性心动过速。室性心动过速是一种严重心律 失常,而室上性心动过速一般预后良好。由于二者的治疗原则不同,因此及时和正确地对宽QRS波心动过速进行鉴别诊断在临床 上有十分重要的意义。本文对宽QRS波心动过速的鉴别诊断和治疗原则予以综述。     

Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia.

AIMS: The Brugada criteria proposed to distinguish between regular, monomorphic wide QRS complex tachycardias (WCT) caused by supraventricular (SVT) and ventricular tachycardia (VT) have been reported to have a better sensitivity and specificity than the traditional criteria. By incorporating two new criteria, a new, simplified algorithm was devised and compared with the Brugada criteria. METHODS AND RESULTS: A total of 453 WCTs (331 VTs, 105 SVTs, 17 pre-excited tachycardias) from 287 consecutive patients with a proven electrophysiological (EP) diagnosis were prospectively analysed by two of the authors blinded to the EP diagnosis. The following criteria were analysed: (i) presence of AV dissociation; (ii) presence of an initial R wave in lead aVR; (iii) whether the morphology of the WCT correspond to bundle branch or fascicular block; (iv) estimation of initial (v(i)) and terminal (v(t)) ventricular activation velocity ratio (v(i)/v(t)) by measuring the voltage change on the ECG tracing during the initial 40 ms (v(i)) and the terminal 40 ms (v(t)) of the same bi- or multiphasic QRS complex. A v(i)/v(t) >1 was suggestive of SVT and a v(i)/v(t) 相似文献   

An electrocardiographic criterion to detect AV dissociation in wide QRS tachyarrhythmias

A study was carried out on 12 patients with wide QRS tachycardia, 8 of whom presented with atrioventricular (AV) dissociation (Group A) and 4 with 1:1 AV association (Group B). This investigation aimed at assessing whether significant variations occurred in the QRS amplitude between the two groups. Group A showed more marked variations in QRS amplitude (31.7 +/- 13%) compared to Group B patients (6.2 +/- 1.2%) (p less than 0.001). The amplitude changes observed in Group A patients are probably related to variations in telediastolic volume resulting from the occasional contribution of the atrial systole. The findings suggest that variability in QRS amplitude during wide QRS tachyarrhythmias is a reliable sign of the presence of an AV dissociation. The possibility of diagnosing an AV dissociation on a surface ECG without visible P waves is an important finding, which though not pathognomonic of ventricular tachycardia, is a valid ECG criterion for assessing the ventricular origin of arrhythmias. This ECG criterion can be usefully applied in clinical practice along with others already used for the differential diagnosis of wide QRS tachyarrhythmias.     

心电图QRS波群振幅的昼夜节律变化及与心率的相关性

目的观察体表心电图QRS波群振幅昼夜节律变化及其与心率的相关性。方法24h动态记录36例健康者Ⅱ导联、Ⅴ1导联、Ⅴ5导联每小时最快、最慢心率时的QRS波群振幅数字和。将1d中24h分成4个时段,比较不同时段测量指标的变化及其与心率的相关性。结果在最慢心率时,Ⅱ导联和Ⅴ1导联QRS波群振幅均呈日高夜低节律变化,Ⅴ5导联与之相反;Ⅴ1和Ⅴ5导联振幅和以及3个导联振幅总和在601～1200时段及0001～0600时段高,1801～2400时段最低;在最快心率时未发现有类似变化。结论QRS波群振幅存在昼夜节律变化并与心率相关,不同导联有不同的变化规律。     

室上性宽QRS波群心动过速的临床分析

目的对自发室上性宽QRS波群心动过速的临床特征、心电图特点进行分析,并用Brugada4步诊断法与室速进行鉴别诊断,评价其敏感性及特异性。方法选择入院时为心动过速的患者,符合窦性P波消失、心室率>100bpm且QRS波群时限≥0.12s,心脏电生理检查明确诊断后,采用单盲法回顾性分析12导联体表心电图的形态学特征,独立做出诊断后,计算Brugada4步诊断法的特异性和敏感性并评价其实用性,同时分析其临床特征及血液动力学改变。结果入选50例室上性宽QRS波群心动过速患者,46例诊断为室上速伴束支阻滞或心室内差异性传导,特异性92%,敏感性100%;心室率<180bpm组与心室率>180bpm组,两组的平均收缩压、平均舒张压及平均动脉压(平均动脉压=舒张压 1/3脉压)均有差别,心室率较快组血压较低,p值<0.05,差别有统计学意义。结论Brugada法对室上性宽QRS波群心动过速的鉴别诊断有重要意义,正确的诊断和及时的处理对患者至关重要。     

Differentiation of Narrow QRS Complex Tachycardia Types Using the 12‐Lead Electrocardiogram

Background: Previous studies have shown that only 80% of narrow QRS supraventricular tachycardia (SVT) types can be differentiated by standard 12‐lead electrocardiographic (ECG) criteria. This study was designed to determine the value of some new ECG criteria in differentiating narrow QRS SVT. Methods and Results : 120 ECGs demonstrating paroxysmal narrow QRS complex tachycardia (QRS s 0.11 ms and rate > 120 beats/min) were analyzed. Forty atrioventricular reciprocating tachycardia (AVRT), 70 atrioventricular nodal reentrant tachycardia (AVNRT), and 10 atrial tachycardia defined with electrophysiologic study (EPS) consisted the study group. Eight surface ECG criteria were found to be significantly different between tachycardia types by univariate analysis. P waves separate from the QRS complex were observed more frequently in AVRT (70%) and atrial tachycardia (80%). Pseudo r’deflection in lead V¹, pseudo S wave in inferior leads, and cycle length alternans were more common in AVNRT (55, 20, and 6%, respectively). QRS alternans was also present during AVRT (28%). ST‐segment depression (≧ 2 mm) or T‐wave inversion, or both, were present more often in AVRT (60%) than in AVNRT (27%). During sinus rhythm, manifest preexcitation was observed more often in patients with AVRT (42%). When a P wave was present, RP/PR interval ratio > 1 was more common in atrial tachycardia (90%). By multivariate analysis, presence of a P wave separate from the QRS complex, pseudo r’deflection in lead V¹, QRS alternans, preexcitation during sinus rhythm, ST‐segment depression > 2 mm or T‐wave inversion, or both, were independent predictors of tachycardia type. Conclusions: Several new ECG criteria may be useful in differentiation of SVT types. Prediction of mechanism prior to EPS may provide additional benefits concerning the fluoroscopic exposure time and cardiac catheterization procedure. A.N.E. 2002;7(2):120–126     

食道心房调搏对窄QRS波室上性心动过速机制研究

目的：了解食道心房调搏（TEAP）对窄QRS波室上性心动过速机制的鉴别。方法：采用无创性TEAP技术,对145例有心动过速史但无器质性心脏病的患者进行检查,诱发窄QRS汉心动过速。结果：检出的窄QES波折返阵性发性室上性心动过速中,房室折返性心;动过速及房室结内折返性心动过速占约大多数,房性折返性心动过速极少。结论：TEAP是鉴别窄QRS波PSVT机制的一种安全,有效的方法。