宽QRS波心动过速鉴别诊断的临床分析

目的分析和对比宽QRS波心动过速(WCT)的鉴别诊断流程图的应用价值。方法对就诊于我院急诊科及心内科并经食管心房调搏、心内电生理检查或射频消融治疗而明确诊断的WCT患者,回顾性分析其病史、心电图、食管调搏或电生理检查及射频消融治疗的结果,研究Brugada四步法、无人区电轴联合aVR导联四步法对WCT诊断的准确率。结果82例WCT患者中,63例为室性心动过速,15例为室上性心动过速伴差异传导,3例为室上性心动过速伴预激前传,1例为双旁道间折返性心动过速。应用Brugada四步法正确诊断71例,正确诊断率86.6%;联合应用无人区电轴及aVR导联四步法,正确诊断75例患者,正确诊断率91.5%。结论联合应用无人区电轴及aVR导联四步法,可使大部分WCT得以正确诊断,提高WCT鉴别诊断的准确率。

Differential diagnosis value of different algorithms In wide QRS complex tachycardia

Objective To study the differential diagnosis value of different algorithms in wide QRS complex tachycardia(WCT).Methods Retrospective analysis was made about the outcome of Brugada algorithm and the aVR lead algorithm combined with axis of "no man's land" in 82 cases of WCT.The results were compared with the final diagnosis confirmed by transesophageal atrial pacing,intracardiac electrophysiological examination or catheter ablation.Results Among the 82 patients with WCT,there were 63 VTs,15 SVTs with aberrant conduction,3 preexcited tachycardias and 1 reentry tachycardia between two pathways.Seventy-one out of 82 WCT patients were correctly diagnosed by Brugada algorithm.The diagnostic accuracy of Brugada algorithm was 86.6%.Seventy-five out of 82 WCT patients were correctly diagnosed by aVR lead algorithm combined with axis of "no man's land".The diagnostic accuracy of the aVR lead algorithm combined with axis of "no man's land" was 91.5%.Conclusion Most WCT patients could be correctly diagnosed by different algorithms.The axis of "no man's land" is useful in differential diagnosis of WCT patients when combined with other algorithms.