Brugada宽QRS鉴别诊断标准对预激综合征患者的价值

THE VALUE OF BRUGADA'S CRITERIA INDIFFERENTIAL DIAGNOSIS OF WIDE-QRS TACHYCARDIAIN PREEXCITATION PATIENTS

通过对７６例预激综合征病人６个同步记录胸导联心电图的观察，研究Ｂｒｕｇａｄａ鉴别室性心动过速（室速）与室上性心动过速（室上速）所致宽ＱＲＳ波群的方法是否适用于预激综合征患者。所有患者的ＱＲＳ均为最大预激图形（ＱＲＳ≥０．１４ｓ）。有多条房室旁路、显著心脏扩大、束支传导阻滞或心肌梗塞的患者均被除外。结果发现：所有７６例的ＱＲＳ图形若按Ｂｒｕｇａｄａ标准均将误诊为室速，其中在第１步判断为“室速”型ＱＲＳ者１４例（１８．４％），第２步判断为“室速”者４７例（６１．９％），第４步判断为“室速”者１５例（１９．７％）。因此，作者认为：①该标准不适用于预激所致宽ＱＲＳ性心动过速（宽ＱＲＳ心速）与室速的鉴别；②该标准在预激征患者中对经房室旁路下传与室内差异性传导所致宽ＱＲＳ心速的鉴别可能有用。

ix-lead precordial electrocardiogram of 76 cases with preexcitation syndrome were stud- ied to evaluate whether the Brugada's method of differential diagnosis of wide-QRS tachycar- dia could be used in the patient with preexcitation syndrome. The QRS intervals of all cases were equal to or greater than 0. 14s. Patients with any of the following conditions had been excluded : multiple accessory pathways, marketlly cardiac enlargement, bundle branch block, and myocardial infarction. Results : According to the Brugada's criteria , all of the 76 cases were fulfilled with the diagnosis of 'ventricular tachycardia', with 18. 4% positivity in Step 1, 61. 9% in Step 2, and 19. 7% in Step 4. Conclusions: (1) The Brugada's criteria should not be used , to differentiate wide-QRS tachycardia between preexciting tachycardia and ventricular tachycardia: (2) The criteria may be useful in preexcitation patients to differ- entiate wide-QRS tachycardia caused by accessory pathway conduction from AVN conduction accompanied by intraventricular aberrency.