酷似阵发性室上性心动过速的心房扑动的心电图特点和诊断

目的：分析酷似阵发性室上性心动过速的心房扑动的心电图并探索其有效诊断方法。方法：选择我院1998~2010年门诊及住院酷似阵发性室上性心动过速的心房扑动病例资料26例,分析其特点及诊断方法价值。结果：（1）心电图特点：F波在Ⅱ、Ⅲ、aVF导联显现25例（96.2%）,在V1导联显现22例;F波在Ⅱ、Ⅲ、aVF导联呈负向22例（84.6%）,呈正向2例,难以辨别方向2例;F波在全部导联中的最大振幅≤0.2mV者5例;F波全部与QRS波和T波融合并使形态发生了变化;（2）诊断根据：①使用工具（分规,放大镜等）主动寻找F波,有25例（96.2%）发现可疑F波;②结合病史,均有器质性心脏病（100%）,9例（34.6%）有阵发性心房颤动史;③与发作前的心电图对照,15例（57.7%）发现有确切F波;④兴奋迷走神经（Valsalva动作等）：适合检查者20例,16例（61.5%,16/26）房室传导比例发生改变,得以确诊;⑤食道心电图：根据心电图诊断20例（76.9%）,余6例（23.1%）可疑者经食道心电图明确诊断。结论：上述方法联合使用,并综合判断可提高心房扑动诊断的准确性。

Electrocardiogram analysis and diagnosis of atrial flutter extremely similar to paroxysmal supraventricular tachycardia

Objective： To analyze electrocardiogram（ECG） characters and explore effective diagnostic methods for atrial flutter（AF）extremely similar to paroxysmal supraventricular tachycardia.Methods： A total of 26 patients with AF extremely similar to paroxysmal supraventricular tachycardia in our hospital from 1998 to 2010 were chosen.Results：（1）Characteristic of ECG： F wave appeared in leads of II,III and aVF was 25 case（96.2%）,and appeared in V1 was 22 cases.F wave in leads of Ⅱ,Ⅲ and aVF appeared negative form in 22 cases（84.6%）,other form in four cases.Maximum amplitude of F wave in all leads ≤0.2mV was five cases.The F wave all fused with QRS wave and T wave,and changed the forms of QRS wave and T wave;（2）Diagnostic evidence： ①Find F wave with diagnostic tools： 25 case（96.2%）had doubtful F wave;②Medical history： All had organic heart disease（100%）,9 cases（34.6%）had paroxysmal atrial fibrillation;③Compare with ECG before attack： There was indeed F wave in 15 cases（57.7%）;④Stimulate vagus nerve： Atrioventricular conduction proportion developed change in 16（61.5%,16/26）after stimulate vagus nerve;⑤The esophageal-ECG： The AF diagnosis based on ECG was 20 cases（76.9%）,based on esophageal-ECG was 6 cases（23.1%）.Conclusion： Joint use of above methods and comprehensive judgment could help to improve the accuracy of diagnosis of atrial flutter.