宽QRS波心动过速的鉴别诊断流程图的应用价值

Application value of differential diagnosis flowchart for tachycardia of wide QRS

目的探讨宽QRS波心动过速的鉴别诊断流程图的临床应用价值。方法选择2008年2月～2012年2月在本院心内科和急诊科就诊并经射频消融治疗、心内电生理检查或食管心房调博确诊为心动过速(WCT)的78例患者,对其病史、射频消融治疗、心内电生理检查以及食管心房调博的结果进行回顾性分析。并研究Brugada四步法、aVR导联四步法联合无人区电轴对于诊断WCT的准确率。结果采用Brugada四步法诊断WCT 69例,正确率为88.46%,采用联合aVR导联四步法及无人区电轴诊断WCT 74例,正确率为94.87%。结论联合应用aVR导联四步法及无人区电轴,可以大幅度地提高WTC诊断正确率,值得临床推广。

Objective To investigate the clinical application value of differential diagnosis flowchart for tachycardia of wide QRS.Methods Seventy eight patients with wide complex tachycardia（WCT） treated in department of cardiology and emergency,who underwent rendered radiofrequency ablation,and confirmed by intracardiac electrophysiological examination and transesophageal atrial pacing in our hospital from February 2008 to February 2012were selected.Their medical history and results of intracardiac electrophysiological examination and transesophageal atrial pacing were retrospectively analyzed.The accuracy rate of Brugada four-step method and four-step method of aVR lead com bined with axis of no-man＇s land in diagnosis of WCT was also studied.Results Sixty nine cases were diagnosed by Brugada four-step method with accuracy rate of 88.46%,74 cases by four-step method of aVR lead combined with axis of no-man＇s land with accuracy rate of 94.87%.Conclusion Application of four-step method of aVR lead and axis of no-man＇s land can significantly improve the accuracy rate of diagnosing WCT and is worth widely clinical ap plying.