体表心电图对宽QRS心动过速的鉴别诊断

The Differential Diagnosis of a Regular Tachycardia with a Wide QRS Complex on the 12-Lead ECG

目的:探讨体表心电图对宽QRS心动过速的鉴别诊断价值。方法:本组76例,男55例,女21例,年龄31.6±15.6岁(12～65岁),除8例冠心病外其余均无器质性心脏病,以上病人均行心内电生理检查。结果:诊断室速的主要ECG标准是:(1)房室分离;(2)QRS波宽度>140 ms,LBBB时>160 ms;(3)胸导QRS波同相性;(4)电轴极度左偏(-90℃±180°);(5)窦性心律时ECG有束支阻滞,心动过速时QRS波形态与其不同。结论:对于宽QRS心动过速鉴别诊断要结合临床资料综合判定,对少数疑难病例需做心内电生理检查才能确诊。

Objective: To evaluate the value of the electrocardiogram(ECG) in the differential diagnosis of a tachycardia with a wide QRS complex. Mothods: A total of 76 patients with wide QRS complex tachy-cardia were enrolled in this study, 55 males and 21 females, aged 31. 6±15. 6 years, medical history in-cluded myocardial infarction in 8, and absence of organic heart disease in 68, All patients underwent com-plete electrophysiological evaluation. Results: Criteria favoring ventricular tachycardia are:(l) Evidence of atrioventricular dissociation(more QRS complex than P waves); (2) Duration of the QRS complex of > 140 msec or with left bundle branch block pattern of QRS complex > 160 msec; (3) Presence of a predomi-nant negative QRS complex in the precordial leads V4、V5 or V6; (4) A left axis of the QRS complex in frontal plan ( - 90 ±180°) ; (5) If the ECG during sinus rhythm with branch block, when the tachycardia was different with QRS complex. Conclusion: The differential diagnosis of wide QRS complex tachycardia should be combined clinical features. Electrophysiological test is needed for difficult.