无人区心电轴对心房颤动伴宽QRS波性质的鉴别价值

目的探讨无人区心电轴对心房颤动伴宽QRS波性质的鉴别价值。方法分析心房颤动伴宽QRS波96例心电图。结果在96例患者中,44例心房颤动伴室性期前收缩（15例心电轴位于无人区）;52例心房颤动伴心室内差异性传导,其心电轴无1例位于无人区。结论心房颤动伴宽QRS波,心电轴位于无人区可以确定为心房颤动伴室性期前收缩,而不是心房颤动伴心室内差异性传导。     

心房颤动伴宽QRS波群与无人区电轴的关系

目的探讨心房颤动（Af）伴宽QRS波群的心电图特点及鉴别。方法对240例Af伴宽QRS波者,经Ⅰ、aVF导联目测心电轴,分析QRS波群形态、心室率及心电轴。结果240例Af中合并室性期前收缩（PVS）或室性心动过速（VT）112例,Af合并室内差异性传导（AVC）128例,22例存在无人区电轴之Af合并PVS或VT。128例Af合并AVC者无一例出现无人区电轴。结论Af合并宽QRS波群伴无人区电轴时,高度提示Af合并PVS或VT。无人区电轴是鉴别Af合并PVS、VT或AVC一项新的重要指标。     

无人区心电轴在宽QRS波群心动过速诊断中的价值

宽QRS波群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室上性心动过速。二者预后及治疗原则不同。故及时和正确进行鉴别诊断十分重要。自2004年7月以来。我们观察了无人区心电轴在宽QRS波群心动过速鉴别诊断中的价值。现报告如下。     

心房颤动时宽QRS波伴无人区电轴的意义

心房颤动时出现宽QRS波，是室早还是房颤伴室内差异性传导，两者的鉴别有重要的临床意义，不仅影响对病情的判断，而且直接决定治疗方案的选择，尤其在使用洋地黄治疗的过程中，如房颤患者出现频发室早，应高度警惕洋地黄过量或中毒，须立即停用洋地黄；如为快速心室率伴室内差传，则可能为     

无人区心电轴对房颤伴宽QRS心动过速的诊断价值

心房颤动(Af)伴宽QRS心动过速,即QRS≥0.12s。心室率>100次/min。常见于:Af伴室性心动过速、Af伴心室内差异性传导、Af伴预激综合征、Af伴束支传导阻滞。由于其心室率快速且心室除极顺序的异常,持续时间较长。可明显影响血流动力学的改变,故其鉴别对诊断治疗有着重要的     

无人区心电轴在宽QRS波心动过速中的鉴别诊断价值

目的探讨无人区心电轴在宽QRS波心动过速(WCT)中的鉴别诊断价值。方法收集并测量北京大学人民医院2000年1月至2005年10月经心内电生理检查明确诊断的WCT患者窦性心律及心动过速时心电图中Ⅰ、Ⅲ标准导联QRS波振幅的代数和,计算QRS波额面平均心电轴,观察无人区心电轴出现的心律失常类型及规律。结果137例[其中特发性室性心动过速(IVT)65例,室上性心动过速(室上速,SVT)72例]明确诊断的WCT患者中,18例出现无人区心电轴,其中室性心动过速(室速)16例(占室速24.6%,占总病例11.7%),均为左心室特发性室速;宽QRS波室上速2例(占宽QRS波室上速2.8%,占总病例1.5%),均为心房颤动(房颤)伴左侧旁路前传。结论无人区心电轴可以作为鉴别室速与宽QRS波室上速的一项可靠指标。     

宽QRS波群心动过速诊断中无人区心电轴的应用价值

宽QRS波群群心动过速的鉴别诊断一直是临床心电图学的一个热点。多数宽QRS波群心动过速是室性心动过速,但也可能是各种室上性心动过速伴     

无人区心电轴对房颤伴宽QRS波心动过速的心电图分析

目的 探讨无人区电轴(NML)用于判别心房颤动(Af)伴宽QRS波心动过速(WQRST)性质的临床意义.方法 分析96例Af并WQRST心电图.结果 96例中54例为Af并心室内差异传导,42例为Af并室性心动过速,其中17例为NML.结论 宽QRS波NML可以确定为Af并室性心动过速,而不是Af并心室内差异传导,具有重要的临床应用价值.     

应用心电散点图鉴别心房颤动伴宽QRS波群的性质

患者女,75岁,有冠心病、房颤,24h动态心电图检测可见较宽大畸形的QRS波群间歇出现,时限120ms,其后无类代偿间歇,RR间期不等,考虑为间歇性室内阻滞,不排除室性自主心律。经心电散点图分析,该患者部分散点分布在动态房室结功能不应期(AVNFRP)界限与X轴之间,且B线斜率趋近于零,诊断为心房颤动伴室性自主心律。     

12导联动态心电图无人区电轴对心房颤动伴宽QRS波分析

目的探讨12导联动态心电图（DCG）无人区电轴对心房颤动伴宽QRS波的鉴别诊断价值。方法分析36例12导联DCG心房颤动伴宽QRS波群的心电图。结果36例中室性期前收缩（PVS）22例,17例存在无人区电轴,占77%,而心房颤动伴室内差异性传导（AVC）14例,无1例存在无人区电轴。结论12导联DCG无人区电轴是心房颤动伴宽QRS波时鉴别诊断的一项指标。     

心房颤动伴短联律间期宽QRS波散点图的类型及特征

目的观察心房颤动(简称房颤)及房颤伴不同起源宽QRS波的心电散点图图形特征。方法对77例房颤及房颤伴短联律间期宽QRS波的病例进行动态心电图诊断,并制作每份病例24 h心电散点图。按照动态心电图诊断,将纳入病例分为房颤组、房颤伴室性早搏组(简称室早组)、房颤伴差异性传导组(简称差传组)、房颤伴预激组(简称预激组),观察各组图形特征。结果房颤组42例、室早组20例、差传组14例、预激组1例。全部病例均呈现有扇形散点图图形,各组又都存在特异性的图形,室早组有房室分离的图形特征,差传组有联律间期"趋短的"图形特征,预激具有经旁道连续房室传导的图形特征。结论在动态心电图中,不同原因导致的频发短联律间期宽QRS波具有不同的心电散点图特征。     

Changing axis deviation during atrial fibrillation

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of changing axis deviation during atrial fibrillation in a 63-year-old Italian woman. Also this case focuses attention on changing axis deviation.     

Changing axis deviation, paroxysmal atrial fibrillation and elevation of prostate-specific antigen during acute myocardial infarction

It has been rarely reported left bundle branch block with changing axis deviation also during acute myocardial infarction. It has also been rarely reported changing axis deviation with changing bundle branch block during acute myocardial infarction. Prostate-specific antigen (PSA) is an established tool in detecting prostate cancer. Immediately after 15 min of exercise on a bicycle ergometer, serum PSA concentrations increased by as much as threefold. Apparently spurious result has been reported in a work about mean serum PSA concentration during acute myocardial infarction with mean serum PSA concentration significantly lower on day 2 than either day 1 or day 3 and it has been reported that these preliminary results could reflect several factors, such as antiinfarctual treatment, reduced physical activity or an acute-phase response. We present a case of changing axis deviation with onset of atrial fibrillation and elevation of serum PSA concentration in an 88-year-old Italian man during acute myocardial infarction. Our report confirms previous findings and extends the evaluation of PSA during acute myocardial infarction.     

Long-term follow-up of right atrial ablation in patients with atrial fibrillation:

INTRODUCTION: The aim of this study was to evaluate the efficacy and the impact on quality of life of a new ablative approach to the right atrium in patients with atrial fibrillation (AF). METHODS AND RESULTS: Seventy-four symptomatic patients with paroxysmal (n = 49) or permanent (n = 25) refractory AF underwent radiofrequency ablation. A nonfluoroscopic electroanatomic mapping system was used to perform the following lesions: (1) an isthmus line between the tricuspid annulus and the inferior vena cava; (2) a posterior intercaval line from the superior vena cava and the inferior vena cava; (3) a septal line from the superior vena cava to the fossa ovalis, proceeding to the coronary sinus ostium where a circumferential line around the ostium was performed, and then on to the inferior vena cava; and (4) a transversal lesion connecting the posterior intercaval and the septal lesions. In addition, electrical disconnection of the superior vena cava was performed. There were no complications. Postablation remapping showed the absence of discrete electrical activity inside and just around the ablation lines. Electrical disconnection of the superior vena cava was obtained in all patients. After 21 +/- 6 months, 49 patients (66%) had stable sinus rhythm with continuation of the previous antiarrhythmic drug therapy, 13 patients (18%) were considered improved, and 12 (16%) received no benefit (unsuccessful procedure). After ablation, quality of life was significantly improved, reaching the levels of the general Italian population. Ejection fraction and the extent of the low-voltage area were found by multivariate analysis to be independent predictors of AF recurrence. CONCLUSION: The results of the present study suggest that this ablative approach in combination with antiarrhythmic drugs is safe and effective in treating AF, leading to a marked increase in quality of life in patients with refractory AF.     

慢性心衰患者QRS时程和新发房颤的相关性研究

目的 探讨慢性心衰患者QRS时程（QRSd）增宽对新发房颤的预测价值.方法 选择患有心衰但无房颤病史的患者1098例,将其分为三组：QRSd≤120 ms、120 ms〈QRSd〈150 ms及QRSd≥150 ms组,随访跟踪各组新发房颤的概率.通过二元分析和多元logistic回归分析探讨QRS时程和房颤新发概率之间的相关性.结果 对患者群体的统计表明,房颤的新发概率为35.7%.通过二元分析发现,房颤的新发概率存在组间差别（21.7%、35.9%、42.5%,P〈0.01）;进一步通过多元回归发现,QRS时程是独立的影响因素.结论 QRS是慢性心衰患者新发房颤的独立预测因素.     

食管心电生理检查鉴别宽QRS波心动过速

目的探讨食管电生理检查在宽QRS波心动过速的诊断应用价值。方法结合心内电生理检查结论,对42例宽QRS波群心动过速（WCT）发作时的食管心电图及体表心电图诊断进行回顾性比较分析,评价食管电生理在诊断WCT中的应用价值。结果与体表心电图诊断结果相比较,食管心电图对WCT的诊断准确度更高,而误诊率、漏诊率更低。结论应用食管电生理能显著提高对WCT的诊断和鉴别诊断水平,在心律失常的治疗上也具有实用价值。     

碎裂QRS波在致心律失常性右心室心肌病诊断中的价值

Objective To evaluate diagnostic value of fragmented QRS complex (fQRS)in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Forty-three patients [33 men, aged (40. 4 ± 13.9)years]meet the ISFC/ESC diagnostic criteria for ARVC were enrolled in this study. A standard twelve-lead electrocardiogram was obtained during the resting status. Characteristics of fQRS were detailedly studied by three doctors independently. A comparison of the prevalence among fQRS, epsilon wave and T wave inversion( TWI )in the right precordial leads exceeding V3 was done. Results Most fQRS could be found in the inferior leads (44. 3% ) and the right precordial leads (24. 2% ). Within the QRS complex, the prevalence of fQRS in the R wave was significantly higher than it in the S wave(58. 4% vs 32. 9% ,Z =4. 30,P ＜0. 01 ).fQRS could be found in a total of 31 of 43 cases( mean 4. 6 ± 1.7 ( range 2 to 9) per patient). The prevalence of fQRS was significantly higher than that of epsilon wave ( 73.8% vs 30. 2%, Z = 3.67, P ＜ 0. 01 ) and TWI (73.8% vs41.9% ,Z =2. 61 ,P＜0. 01 ). Conclusion fQRS was a common electrocardiographic abnormality,and most was found in the inferior and right precardial leads in patients with ARVC. It may be used as an important noninvasive preliminary screening electrocardiographic criteria.     

Fragmented QRS may predict new onset atrial fibrillation in patients with ST-segment elevation myocardial infarction

Background

Fragmented QRS (fQRS) has been shown to be a marker of local myocardial conduction abnormalities, cardiac fibrosis in previous studies. It was also reported to be a predictor of sudden cardiac death and increased morbidity and mortality in selected populations. However, there is no study investigating the role of fQRS in the development of atrial fibrillation in patients with ST segment elevation myocardial infarction (STEMI). In this study we aimed to investigate the relationship between the presence of fQRS after primary percutaneous coronary intervention (pPCI) and in-hospital development of new-onset atrial fibrilation (AF) in patients with STEMI.