三度房室阻滞误诊原因分析

Study on the reason of misdiagnosing complete Atrioventricular block.

目的通过对既往诊断为三度房室阻滞的心电图资料的再分析,阐述三度房室阻滞的完整诊断标准及其原理。方法回顾性研究3家医院218例诊断为三度房室阻滞的心电图资料,统一以房室分离且满足:①RR间期>2倍的PP间期;②心室率<50bpm;③心房率<135bpm的诊断标准进行再诊断。结果经正确性评定原诊断正确者197例(90.4%),误诊者12例(5.5%),不确定者9例(4.1%)。误诊的12例心电图中,7例为二度2:1房室阻滞合并干扰性房室脱节,4例为高度房室阻滞合并干扰性房室脱节,1例为加速性交界区自主心律合并干扰性房室脱节。结论以“房室分离且房率快于室率”作为三度房室阻滞的诊断标准是不充分的,还应辅以“房率和室率都不太快、室率慢于房率的1/2”,才是完整的诊断标准。足够的心电图资料是确诊的重要保障。

Objective To investigate the diagnostic criteria and its principle of complete Atrioventricular block through re-analyzing the ECG data diagnosed complete Atrioventricular block. Methods 218 ECG data diagnosed complete Atrioventricular block from 3 hospitals were studies retrospectively. They were all re-diagnosed in terms of the following dignostic criteria： ①atrioventricular dissociation. ②RR interval is longer than the twice PP interval. ③RR interval is longer than 1200ms. 4. PP interval is longer than 444ms. Results 197 cases （90.4%） were correctly diagnosed, howere, 12 cases were misdiagnosed and the correct diagnoses of other 9 cases were uncertain. Among 12 misdiagnosed cases, 7 cases were re-diagnosed as 2：1 AVB with atrioventricular interference dissociation, 4 cases were re-diagnosed as high degree atrioventrieuLar block with atrioventricular interference dissociation and the other one was re-diagnosed as accelerated junctional independence cardiac rhythm with atrioventricular interference dissociation. Conclusion Atrioventricular dissociation and faster atria rate than ventricle rate are not enough for diagnosing complete Atrioventricular block. The complete diagnostic criteria should include the following atria rate and ventrieular rate are not too fast and ventricle rate is slower than half of atria rate. The enough ECG data is very important for the final diagnosis of complete Atrioventricular block.