文章摘要
赵 健,邹建刚,刘 平.体表心电图在特发性左室室速和宽QRS波室上性心动过速鉴别诊断中的应用价值[J].南京医科大学学报,2008,28(12):1591~
体表心电图在特发性左室室速和宽QRS波室上性心动过速鉴别诊断中的应用价值
Evaluation of surface electrocardiogram clues for differential diagnosis of idiopathic left ventricular tachycardia and wide QRS complex supraventricular tachycardia
投稿时间:2008-07-30  
DOI:10.7655
中文关键词: 体表心电图  特发性左室室速  宽QRS波  室上性心动过速  电生理
英文关键词: Idiopathic left ventricular tachycardia  Wide QRS complex  Tachycardia  Surface electrocardiogram  Electrophysiological study
基金项目:
作者单位
赵 健 中国人民解放军第81医院心内科,江苏 南京 210002 
邹建刚 南京医科大学第一附属医院心内科,江苏 南京 210029 
刘 平 中国人民解放军第81医院心内科,江苏 南京 210002 
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中文摘要:
      目的:评价体表心电图对特发性左室室速和宽QRS波室上性心动过速(SVT)的鉴别诊断价值?方法:回顾性分析75例经心内电生理检查确诊?呈右束支阻滞(RBBB)型且无器质性心脏病的宽QRS波心动过速(WCT)患者体表心电图资料?结果:房室分离?心室夺获或室性融合波?无人区心电轴(-90°~±180°)或电轴左偏?下壁导联(Ⅱ?Ⅲ?avF)以S波为主?Ⅰ导联呈Rs波?avL导联呈Rs或qR(s)?V6导联呈rS型?心动过速终止恢复窦性心律时出现电张调整性T波改变对特发性左室室速诊断有较高的应用价值;而电轴正常或右偏?下壁导联以R波为主?avL导联呈rS或QS型?V6导联呈Rs型对诊断宽QRS波SVT有价值?结论:体表心电图可有效地用于RBBB型无器质性心脏病WCT的鉴别,本研究表明若干体表心电图特征可用于特发性左室室速和宽QRS波SVT的鉴别?
英文摘要:
      Objective:To evaluate the value of surface electrocardiogram clues for the differential diagnosis of idiopathic left ventricular tachycardia and wide QRS complex supraventricular tachycardia. Methods:Surface ECGs and clinical data of 75 patients with wide QRS complex tachycardia of right bundle branch block type and without organic heart disease were analyzed retrospectively, and the final diagnoses were made by intracardiac electrophysiological study. Results:The valuable surface ECG clues for the diagnosis of idiopathic left ventricular tachycardia were as follows:(1) evidence of atrioventricular dissociation, (2)evidence of capture or fusion beats, (3)axis of “no man’s land”(-90°~180°) or left axis deviation, (4)negative direction S wave is predominating in inferior wall leads(Ⅱ?Ⅲ and avF),(5)QRS morphology in lead Ⅰ was characterized biphasic Rs wave; QRS morphology in lead avL was Rs or qR or qRs;QRS morphology in lead V6 was characterized biphasic rS wave;(6)it occurs transient reversible T change during sinus rhythm after tachycardia termination. And the valuable surface ECG clues for the diagnosis of superventricular tachycardia with wide QRS complex were as follows: (1)normal axis or right axis deviation, (2)positive direction R wave is predominating in inferior wall leads(Ⅱ?Ⅲ and avF); QRS morphology in lead avL was biphasic rS or QS;(3)QRS morphology in lead V6 was characterized biphasic Rs wave. Conclusion:Surface ECG clues are valuable for differential diagnosis of wide QRS complex tachycardia of right bundle branch block type and without organic heart disease. Several features are extracted in this text for differential diagnosis idiopathic left ventricular tachycardia and supraventricular tachycardia of wide QRS complex.
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