形态心电图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 the Specificity of Morphological Electrocardiographic Criteria for the Differential Diagnosisin Patients With Wide QRS Complex Tachycardia Following Previous Bundle Branch Block

为探讨形态心电图标准是否适用原有束支阻滞（ＢＢＢ）或心肌梗塞患者合并宽ＱＲＳ波群心动过速的鉴别诊断，选择窦性心律呈ＢＢＢ的患者２０５例［左束支阻滞（ＬＢＢＢ）４５例、右束支阻带（ＲＢＢＢ）１６０例］，分析形态心电图标准用于鉴别宽ＱＲＳ波群心动过速的特异性。胸导联ＱＲＳ波群图形一致、胸导联无ＲＳ型；ＲＢＢＢ时任一胸导联ＲＳ时限＞１００ｍｓ，Ｖ１导联单向（Ｒ）或双向（ｑＲ、ＱＲ、ＲＳ）、呈左兔耳征，Ｖ６导联或ａＶＦ导联Ｑ波，Ｖ６导联Ｒ／Ｓ＜１；ＬＢＢＢ时，Ｖ１、Ｖ２导联ｒ波时限＞３０ｍｓ，Ｖ１、Ｖ２导联Ｓ波降支钝挫，Ｖ６导联或ａＶＦ导联ｑ（Ｑ）波等１２条特异性较高。ＱＲＳ波群时限＞１４０ｍｓ；ＲＢＢＢ时电轴重度左、右偏，ａＶＦ导联Ｒ／Ｓ＜１；ＬＢＢＢ时Ｖ１、Ｖ２导联ＲＳ时限＞６０ｍｓ，Ⅰ导联负向ＱＲＳ波群，Ｖ４较Ｖ１导联Ｓ波振幅更深等７条特异性较低。心肌梗死合并宽ＱＲＳ波群心动过速时采用上述标准鉴别诊断有一定局限。

To explore whether the morphological electrocardiographic criteria were applicable to the patients with previous bundle branch block (BBB) or myocardial infarction following wide QRS complex tachycardia in the differential diagnosis.The morphological electrocardiographic criteria were used to identify the specificity of wide QRS complex tachycardia among 205 patients with BBB (45 patients with left BBB and 160 with right BBB) in sinus rhythm.Results:The following criteria including the presence of a concordant pattern in all precordial leads,absence of a RS pattern in all precordial leads with the presence of BBB,any interval>100 ms from the onset of the R wave to the nadir of the S wave in precordial leads with an RS morphology,dominant (R) or biphasic (qR.QR.RS) wave or a left rabbitear configuration in lead V1,any Q wave in lead V6 or lead aVF,R/S<1 in lead V6 in the presence of right BBB,r wave in lead V1 or V2>30 ms,notched downstroke S wave in lead V1 or V2,any Q wave in lead V6 or lead aVF in the presence of left BBB,all of the 12 criteria had high specificity.In contrast,the following 7 criteria including QRS duration>140 ms,left superior axis deviation (-30-90) or right superior axis deviation (-90180),R/S<1 in lead aVF in the presence of right BBB,>60 ms from the QRS onset to the nadir of the S wave in lead V1 or V2,negative wave in lead I,the amplitude of S wave in lead V4 more deeper than lead V1 had lower specificity.In patients with myocardial infarction accompanying wide QRS complex tachycardia,it would be restraint when use above criteria for the differential diagnosis.