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。

The study of differential diagnosis value of the axis of "no man''''s land" in wide QRS complex tachycardia

Objective Study the differential diagnosis value of the axis of "no man's land" in wide QRS complex tachycardia.Methods Retrospectively analyse the axis of "no man's land" in 137 patients with wide complex tachycardia who had undergone intracardiac electrophysiologic studies,use the algebraic sum of the deflections in leads I and III to plot the QRS axis,to observe the rule of arrhythmia of "no man's land" appearance.Results Eighteen of 137 patients who had wide complex tachycardia had the axis of "no man's land",among which 16 patients had left idiopathic ventricular tachycardia,and 2 patients had wide complex supraventricular tachycardia they had accessory pathway conduct anterogradely.Conclusion The axis of "no man's land" is helpful in differential diagnosis of ventricular and supraventricular tachycardias with abberency or bundle branch block.