心房扑动2︰1房室传导心电图误诊30例分析

Misdiagnosis Analysis of Atrial Flutter 2 ︰ 1 Atrioventricular Conduction in 30 Cases

目的探讨心房扑动(atrial flutter,AFL)2︰1房室传导心电图误诊原因及提高辨别率措施。方法回顾性分析我院心功能室2014年1月—2015年2月收治的30例AFL 2︰1房室传导心电图误诊病例资料。结果本组误诊为室上性心动过速28例,窦性心动过速及完全性右束支传导阻滞各1例。其中25例(83.33%)为低年资心电图诊断医师误诊,5例(16.67%)为高年资诊断医师误诊。30例均经本室上级诊断医师审核复读时修正诊断,未因误诊造成不良后果。30例确诊后均予胺碘酮复律,23例(76.67%)转为窦性心律。结论 AFL 2︰1房室传导易误诊为室上性心动过速,加强对不典型AFL心电图的认识、规范心电图操作、灵活运用Bix法则、结合患者病史并动态观察,可避免或减少该型AFL心电图的误判。

Objective To explore the cause of misdiagnosis of atrial flutter 2 ： 1 atrioventricular conduction, and measures to improve the identification rate. Methods Retrospective analysis was conducted in our hospital cardiac function room between January 2014 and February 2015 on 30 misdiagnosed cases of atrial flutter 2 ： 1 atrioventricular conduction electrocardiogram （ECG）. Results 28 cases of atrial flutter 2 ： 1 atrioventricular conduction were misdiagnosed as supraventricular tachycardia, and on one case of sinus tachycardia and complete right bundle hranch hlock. ECG junior doctors had 25 misdiagnoscd cases （83.33%） , and senior doctors had 5 cases （ 16.67% ）. 30 cases were corrected by the doctors in our department during reassessment. There were no adverse consequences of misdiagnosis. 30 cases were treated with amiodarone after diagnosis. 23 cases （76.67%） converted to sinus rhythm. Conclusion Atrial flutter 2 ： I atriuventricular conduction tend to be misdiagnosed as supraventrieular tachycardia, and physicians should strengthen the understanding of atypical AFL electrocardiogram, standardize ECG operation, use of Bix law in a flexible way in combination with the patient medical, in order to avoid or reduce this type of AFL ECG misjudgment.