鉴别宽QRS心动过速心电图指标对原有束支传导阻滞患者的应用价值

目的　探讨鉴别宽 QRS心动过速心电图指标对原有束支传导阻滞患者的应用价值。方法　以非选择性、连续性 42 0例完全性束支传导阻滞窦性心律患者为研究对象 ,分析以往文献报道鉴别宽 QRS心动过速心电图标准中的 QRS形态指标的特异性。结果　 12个分析指标中 4个指标特异性 >90 % :右束支传导阻滞 V1 呈三相型 (Rsr′,r SR′,RSR′) ;右束支传导阻滞 V6呈 QS或 QR型 ;左束支传导阻滞 V6有 q或 Q波 ;V1 ～ V6无 RS波。其它 8个指标特异性在 45 %～ 87%范围内。结论　有利于室性心动过速诊断心电图标准中的 QRS形态指标对鉴别原有束支传导阻滞的室上性心动过速患者存在局限性

The Value of electrocardiographic criteria for the differential diagnosis of wide QRS tachycardia in patients with preexisting bundle branch block

Objective To evaluate the applicable value of electrocardiographic criteria for the differential diagnosis of wide QRS tachycardia in patients with preexisting bundle branch block. Methods The 12 lead EKGs of 420 unselected consecutive patients with preexisting bundle branch block during sinus rhythm were amalyzed to determine the specificity of 12 QRS morphological criteria previously described in electrocardiographic criteria for the differential diagnosis of wide QRS tachycardia. Results 4 analyzed criteria had a specificity of 97%, 98%, 94%,93% a triphasic configuration (Rsr′,rSR′,RSR′) QRS complex in V 1 with right bundle branch block morphology (BBBM); a QS, QR QRS pattern in V 6 with right BBBM; a q or Q in V 6 with left BBBM; the absence of an RS in V 1～V 6. The specificity of the other criteria was 45%,57%,85%,87%,75%,72%,75%,71%, respectively. Conclusion The QRS morphological criteria favoring ventricular tachycardia in electrocardiographic criteria for the differential diagnosis of wide QRS tachycardia have limited clinical value in patients with preexisting bundle branch block who develop supraventricular tachycardia.