无人区电轴对房颤伴宽QRS波的鉴别诊断价值

The differential diagnosis value of "no man's land" and "rabbit ear sign" in atrial fibrillation complicated with wide QRS wave

目的探讨无人区电轴与兔耳征对心房颤动(AF)伴宽QRS波的鉴别诊断价值。方法对65例AF合并宽QRS波者,经综合判断为AF合并室性期前收缩(PVS)40例,AF合并室内差异传导(差传)25例。经体表心电图I、aVF导联目测心电轴,根据V1导联QRS波形态判断有无兔耳征。结果 65例中,11例存在无人区电轴者均发生于AF合并PVS,无一例出现于AF合并差传者。13例左兔耳征者亦均发生于AF合并PVS。两者诊断AF合并PVS的特异性均达100%。22例右兔耳征者中有15例为AF合并差传。结论无人区电轴及左兔耳征均可作为鉴别AF合并PVS或差传的指标,两者特异性均很高,具有重要的临床意义,但敏感性较低。

Objective To research the differential diagnosis value of axis of ＂no man＇s land＂ and ＂rabbit ear sign＂ in atrial fibrillation complicated with wide QRS wave. Methods 65 patients with AF complicated with wide QRS wave were included in this study. After a comprehensive judging,there were 40 patients with AF complicated with ventricular premature beats and 25 patients with aberration. To measure Ⅰ、aVF lead cardiac electric axis with visual measurement by electrocardiogram,and according to morphology of QRS wave in lead V1 to determine whether the rabbit ear sign. Results In 65 patients,11 cases with axis of ＂no man＇s land＂ and all of them occurred in AF complicated with ventricular premature beats,and no one was in AF complicated with aberration. 13 cases with ＂left rabbit ear sign＂ also all occurred in AF with ventricular premature beats. So the specificity of each method in diagnosising AF with ventricular premature beats was 100%.22 cases with ＂right rabbit ear sign＂ ,and AF with aberration occurred in 15 cases. Conclusion The axis of ＂no man＇s land＂ and ＂left rabbit ear sign＂ can be used as an index of differential diagnosis of AF complicated with ventricular premature beats or aberration. Both specificity is high,and has Important clinic significance,but the sensitivity is poor.