十二导联心电图诊断线索对宽QRS波心动过速的临床价值

The clinical value of 12-lead ECG clues in patients with wide QRS complex tachycardia

目的分析十二导联心电图诊断线索对宽QRS波心动过速(wide QRS complex tachycardia,WQRST)的临床价值,探索Ⅱ导联QRS波第1峰时限(R-wave peak time,RWPT)≥50 ms和Ⅱ导联QRS波时限≥130 ms对室性心动过速(ventricular Tachycardia,VT)和室上性心动过速(supraventricular tachycardia,SVT)的鉴别诊断意义。方法回顾性地分析就诊于黄冈市中心医院的198例WQRST(心率>100次/min且QRS时限>0.12 s)患者。并经心脏电生理学检查明确诊断,记录并分析十二导联心电图对WQRST的鉴别诊断线索,记录所有十二导联心电图的Ⅱ导联QRS波第1峰时限及Ⅱ导联QRS波时限。结果区别VT和SVT的主要诊断线索有QRS波时限、QRS波心电轴、QRS波正负同向性、房室分离、室性融合波和心室夺获、胸前导联RS是否缺失及时限、窦性心律时是否伴显性预激或同形态室性早搏、Vi/Vt≤1、V1和V6导联特殊形态学诊断标准等。除V1、V6负向一致性差异无统计学意义外,其余各个指标差异均有统计学意义(P<0.05),Ⅱ导联RWPT≥50 ms时能够较好地区分VT和SVT,敏感度和特异度分别为0.89、0.85。结论十二导联心电图是WQRST鉴别诊断的重要方法之一,在临床中应该灵活运用各种诊断线索。Ⅱ导联RWPT≥50 ms能够作为区分VT和SVT一种简单实用的鉴别标准,用于重症监护室和急诊科等。

[ Objective] To analyze the clinical value of 12-lead ECG clues in patients with wide QRS complex tachycardia （WQRST） , explore the value of ECG lead II R-wave peak time （RWPf） ≥50 ms and QRS width≥130 ms in differentiating the ventricular tachycardia （VT） from supraventricular tachycardia （SVT） in patients with WQRST. [Methods] 198 patients with WQRST （heart rate more than 100 beats per minute and QRS greater than 0. 12 second） in Huanggang Center Hospital of Hubei were retrospectively analyzed. All the patients were diagnosed by the intracardiac electrophysiological examination. All the 12-lead ECG clues in WQRST patients was recorded and evaluated. RWPf duration and QRS width at ECG lead II were also recorded. [ Results] The valuable 12-lead ECG clues for differential diagnosis of VT and SVT were as follows： QRS width, QRS axis, QRS concordance, atrioventricular dissociation, ventricular fusion beats/ ventircular chaotic, precordial leads RS absent and duration, whether it is accompanied with manifest preexcitation and ventricular premature beats during sinus rhythm, Vi/Vt≤ 1, and special morphological diagnostic criteria in lead VI and V6. Except that the differences in negative consistency of lead VI and V6 were not significant, the differences in other indexes were significant （P 〈 0. 05）. ROC curve demonstrated RWPf≥ 50 ms at lead II showed better specificity and sensitivity in distinguish VT from SVT, which the specificity and sensitivity was O. 89 and 0.85 respectively. [Conclusion] 12-lead ECG clues are useful for differential diagnosis of WQRST, and various diagnosis clues must be flexible to apply in clinical practice. RWPf≥50 ms at lead II can be used as a simple and practical identification standard for distinguishing VT from SVT, which is suitable for intensive care unit and emergency department.