形态心电图标准在宽QRS波心动过速鉴别诊断中的价值

目的:为评价形态心电图单项标准、多项组合的Brugada标准及Brugada标准联合Steurer标准在宽QRS波心动过速(WRT)鉴别诊断中的应用价值及存在的缺陷。方法:对112例WRT室性心动过速(VT)64例,室上性心动过速(SVT)48例]发作时的常规12导联心电图进行分析。结果:形态心电图单项标准诊断VT的敏感性不高,但部分单项标准的特异性很强(100%),一旦出现,强烈提示VT;多项组合的Brugada标准可提高VT诊断的敏感性(93.8%)及准确性(86.6%),但特异性较低(77.1%);Brugada标准联合Steurer标准可进一步提高诊断VT的特异性(89.6%)及准确性(92.0%)。进一步分析显示:Brugada标准对器质性原因所致VT、右束支传导阻滞型(RBBB)特发性VT(IVT)、SVT伴室内差异性传导(AC)或原有单侧束支传导阻滞(BBB)者诊断符合率高(96.3%~100.0%);对左束支传导阻滞型(LBBB)特发性VT、SVT伴原有双支阻滞、心肌坏死或心肌梗死伴宽QRS波SVT及预激综合征(WPW)伴旁道前传型SVT(WPW-SVT)诊断的符合率低(0~57.1%)。联合Steurer标准可使WPW-SVT得以明确诊断,但对前三者无鉴别意义,故不适合在前三者中应用。结论:形态心电图单项标准诊断VT的敏感性较低,不能依赖某一单项标准判断VT,多项组合的Brugada标准联合Steurer标准是目前诊断VT敏感性、特异性、准确性较强的方法。

Value on differential diagnosis of morphological electrocardiographic criteria for broad complex tachycardia

Objective: To explore the value and existential defect of the single item or many items composed morphological electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia. Method:One hundred and twelve patients, 64 with ventricular tachycardia(VT), 48 with supraventricular(SVT), their 12 leads electrocardiogram were studied retrospectively. Result:The sensitivity were low in single item morphological electrocardiographic criteria, but specificity were high in part which for the diagnosis VT;The sensitivity , specificity and accuracy were 93.8%,89.6% and 92.0% in many items composed Brugada's criteria with Steurer's criteria; they were higher than those of Brugada's criteria(93.8%,77.1%,86.6%). Further analysis showed: Brugada's criteria with Steurer's criteria had a high coincidence rate for diagnosis of VT with organic heart disease,SVT with intraventricular aberrant conduction or bundle branch block(BBB) and Wolff-Parkinson-White syndrome(WPW) with SVT of bypass anterograde conduction. But they were low coincidence rate for diagnosis of idiopathic ventricular tachycardia(IVT) with left BBB, SVT with bifascicular block or myocardial necrosis and myocardial infarction.They were easier to be misdiagnosis. Conclusion:The sensitivity were low for diagnosis VT in single item morphological electrocardiographic criteria,it cannot diagnose VT with sigle criteria. The many items composed Brugada's criteria with Steurer's criteria were more sensitivite, specific and accurate for diagnosis currently.