共查询到20条相似文献,搜索用时 15 毫秒
1.
András Vereckei Gábor Duray Gábor Szénási Gregory T Altemose John M Miller 《European heart journal》2007,28(5):589-600
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
2.
3.
New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. 总被引:7,自引:0,他引:7
András Vereckei Gábor Duray Gábor Szénási Gregory T Altemose John M Miller 《Heart rhythm》2008,5(1):89-98
BACKGROUND: We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. OBJECTIVE: The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. METHODS: In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (v(i)/v(t)), the vertical excursion (in millivolts) recorded during the initial (v(i)) and terminal (v(t)) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, v(i)/v(t) >1 suggested SVT, and v(i)/v(t) < or =1 suggested VT. RESULTS: The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria. CONCLUSION: The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm. 相似文献
4.
A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex 总被引:43,自引:0,他引:43
BACKGROUND. In the differential diagnosis of a tachycardia with a wide QRS complex (greater than or equal to 0.12 second) diagnostic mistakes are frequent. Therefore, we investigated the reasons for failure of presently available criteria, and we identified new, simpler criteria and incorporated them in a stepwise approach that provides better sensitivity and specificity for making a correct diagnosis. METHODS AND RESULTS. A prospective analysis revealed that current criteria had a poor specificity for the differential diagnosis. The value of four new criteria incorporated in a stepwise approach was prospectively analyzed in a total of 554 tachycardias with a widened QRS complex (384 ventricular and 170 supraventricular). The sensitivity of the four consecutive steps was 0.987, and the specificity was 0.965. CONCLUSIONS. Current criteria for the differential diagnosis between supraventricular tachycardia with aberrant conduction and ventricular tachycardia are frequently absent or suggest the wrong diagnosis. The absence of an RS complex in all precordial leads is easily recognizable and highly specific for the diagnosis of ventricular tachycardia. When an RS complex is present in one or more precordial leads, an RS interval of more than 100 msec is highly specific for ventricular tachycardia. This new stepwise approach may prevent diagnostic mistakes. 相似文献
5.
单独用aVR导联鉴别诊断宽QRS波心动过速——附200份心电图分析 总被引:2,自引:0,他引:2
目的:应用Verecki新提出的单独运用aVR导联新法则对宽QRS 波心动过速进行鉴别诊断,评价其敏感性、特异性、阳性预测值、阴性预测值及诊断符合率.方法:选择200份经电生理检查诊断明确的宽QRS 波心动过速的心电图,采用单盲法由2位研究人员运用aVR导联新法则进行回顾性分析,并进行一致性检验后,统计aVR导联新法则每一步的诊断情况,计算敏感性、特异性、阳性预测值,阴性预测值及诊断符合率.结果:运用aVR导联新法则诊断的敏感性为97.6%,特异性为 67.7%,阳性预测值94.3%,阴性预测值为84.0%,诊断符合率为93.0%,对左室特发性室速的误诊例数为0.结论:单独运用aVR导联进行诊断具有高效准确,特别适合左室室速的鉴别诊断,适合临床应用. 相似文献
6.
aVR导联四步流程在宽QRS波心动过速鉴别诊断中的应用 总被引:2,自引:0,他引:2
目的 验证分析aVR导联四步流程对宽QRS波心动过速(WCT)进行鉴别诊断的应用价值.方法 回顾性分析113例患者发生WCT时12导联体表心电图的形态学特征.按aVR导联四步流程分步骤地对113例WCT患者的心电图进行室性心动过速(室速)和室上性心动过速(室上速)的鉴别,将分析的结果与电生理检查结果进行比较,计算每一步... 相似文献
7.
8.
Differential diagnosis between premature ventricular contraction (PVC) and premature supraventricular contraction with aberrant ventricular conduction (A-PSC) has often been inaccurate or even unavailable in widely used real-time autointerpretation electrocardiograms (ECGs), while the therapeutic strategy is completely different in the forefront of clinical practice. Although detection of the ectopic P wave (P') is essential to make an accurate diagnosis, it is too complicated and time-consuming to be taken on the ECG machine. Thus, we made a new simple algorithm to detect P' using several mathematical techniques and evaluated its diagnostic accuracy in making differential diagnosis between PVC and A-PSC in comparison with a conventional method which has no P' detection. The outline of the signal-processing for P' detection is as follows:
- 1.(1) Second derivatives: D(n) = E n-5 + En+5 − 21E(n);
- 2.(2) Absolute values: A(n) = |D(n) II| + |D(n) III| + |D(n) VI|;
- 3.(3) Smoothing: W(n) = (A(n) + A(n+1) + ⋯ + A(n+9)/10;
- 4.(4) T wave subtraction: preceding T wave - dominant T wave;
- 5.(5) P′ wave detection: W(n-1) ≤ W(n) > W(n+1) & W(n-5) ≤ W(n) > W(n+5)
N = 180 | TP | TN | FP | FN | Sens | FP% | Accuracy |
Conventional logic | 10 | 129 | 37 | 4 | 71.4 | 22.3 | 77.2 |
New logic | 10 | 161 | 5 | 4 | 71.4 | 3.0 | 95.0 |