应用改良体表心电图三步法鉴别常见阵发性室上性心动过速临床评价

Modified electrocardiographic algorithm for differentiating typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway

目的探讨典型房室结折返性心动过速和经隐匿性旁道介导房室折返性心动过速的常用心电图鉴别诊断指标,提出并评价改良的鉴别诊断方案。方法收集2003年1月至2005年11月北京大学人民医院收治的154例患者窦性心律和心动过速发作时的心电图。在分析104例患者的心电图之后提出改良诊断方案,并利用50例患者的心电图进行评价。结果改良方案诊断房室结折返性心动过速及房室折返性心动过速的准确率分别为84%和87%,观察者间的符合率为85%,观察者内的符合率均为89%。结论改良诊断方案可以提高这两种心动过速的心电图鉴别诊断准确率。

Objective To evaluate the frequently used electrocardiographic criteria and propose a modified algorithm for differentiating typical atrioventrieular node reentrant taehyeardia （AVNRT） from atrioventrieular reciprocating tachyeardia （AVRT）. Methods Twelve- lead electrocardiograms （ECGs） during sinus rhythm and atrioventrieular node reentrant taehyeardia （AVNRT） or atrioventricular reciprocating tachycardia （AVRT） with a narrow QRS complex were obtained from 154 patients who had received successful radiofrequeney catheter ablation from Jan. 2003 to Nov. 2005. The ECGs of initial 104 patients were analyzed by 3 observers without knowledge of the eleetrophysiologieal diagnosis. According to these initial results, we proposed a modified stepwise ECG algorithm which used pseudo r＇/S/Q waves, RP interval, and ST - segment elevation in lead aVR during taehyeardia. Two observers assessed the algorithm in additional 50 patients. Results The algorithm was able to increase the overall accuracy from 77% and 79% with original algorithm to 84% and 87% with the modified algorithm, respectively. The inter -observer concordance was 85%. The intra - observer concordance was 89% in both investigators. Conclusion The modified algorithm can improve the accuracy of differential diagnosis between typical AVNRT and AVRT via concealed accessory pathway.