“心电图形态学标准”在原有束支阻滞伴宽QRS波群心动过速鉴别诊断中的特异性评价

Evaluation of specificity of morphological electrocardiographic criteria for differential diagnosis in patients with wide QRS complex tachycardia following previous bundle brandle block

目的探讨心电图形态标准是否适用于原有束支阻滞(BBB)或心肌梗死患者合并宽QRS波群心动过速(WRT)的鉴别诊断。方法选择窦性心律时呈BBB的患者359例[左束支阻滞(LBBB)98例,右束支阻滞(RBBB)261例],分析心电图形态标准用于鉴别WRT的特异性。结果胸前导联图形一致,胸前导联无RS图形;RBBB时电轴重度右偏(-90～±180°)、V1导联呈左兔耳征(Rsr`.Rr`)、V6导联呈QR、QS、R形或R/S<1、aVF导联呈Qr、QR、QS形;LBBB时V1～V2导联S波降支钝挫、V6导联q(Q)波、aVF导联呈QS、qR形,Ⅰ导联呈qR、rS、Rs形等11项标准特异性较高(87.7～100%)。另8项标准特异性较低。心肌梗死并WRT(尤其QRS呈RBBB)时采用上述标准鉴别诊断有一定局限性。结论部分心电图形态标准适用于原有BBB伴WRT的鉴别诊断,但对心肌梗死并WRT的鉴别价值有限。

Objective To explore whether the morphological electrocardiographic criteria were applicable to the patient with previous bundle brank block （BBB） or myocardial infarction following wide QRS complex tachycardia in the differential diagnosis. Methods The morphological electrocardiographic criteria were used identify the specificity of wide QRS complex tachycardia among 359 patients with BBB（98 with left BBB, 261with right BBB） in sinus rhythm. Results The following criteria including the presence of a concordial pattern in all precordial leads, absence of a RS pattern in all precordial leads with the presence of BBB; when they QRS complex were right BBB,a left rabbit-ear configuration in lead V1, QS,qR,R wave or R/S〈1 in lead V6, Qr, QR, QS wave in lead aVF; when they QRS complex were left BBB, notched downstroke S wave in lead V1 or V2, any q（Q） wave in lead V6 or aVF, qR,rS,Rs wave in lead Ⅰ, all of the 11 criteria had high specificity in patients with myocardial infarction accompanying wide QRS complex tachycardia it would be restraint when use above criteria for the differential diagnosis. Conclution Part morphological electrocardiographic criteria had high value of differential diagnosis to patients with previous BBB,but its had no value for that to which with myocardial infarction following wide QRS complex tachyeardia.