宽QRS波心动过速的远程心电诊断

The remote electrocardiogram diagnosis of wide-QRS complex tachycardia

目的根据远程心电诊断中阵发性宽QRS波心动过速的心电图特点,探讨宽QRS波心动过速鉴别诊断要点的临床实用价值。方法 2016年1月1日至2017年12月31日,上海交通大学远程心电诊断中心所有数字化心电图数据入选统计。结果宽QRS波心动过速的总体发生率0.02%。符合入选标准者276人次,心电图采自于176例病例。心电图特点:(1)心动过速频率:(174.76±31.19)次/分;(2)QRS波时间:(158.51±47.87)ms。(3)QRS波电轴:(89.62±112.41)°。(4)根据2015ACC/AHA/HRS指南,符合室性心动过速者94例(53.41%);符合室上性心动过速者82例(46.59%)。2015ACC/AHA/HRS指南推荐的鉴别诊断要点中,最常见的是aVR导联QRS波形态特征(Vereckei算法),总体发生率为33.11%,其次是V1～V6导联QRS波形态特征(Brugada标准),总体发生率为20.45%。结论在宽QRS波心动过速中,以室性心动过速为常见;在鉴别诊断时,推荐关注aVR导联QRS波形态特征。

Objective To investigate the clinical practical value of the differential diagnosis in wide-QRS complex tachycardia according to the electrocardiogram （ECG） characteristics of paroxysmal wide-QRS complex tachycardia by remote ECG diagnosis. Methods Total digital ECGs recorded from January 1st, 2016 to December 31st, 2017 in the Shanghai Jiaotong University Remote ECG Diagnosis Center were admitted into statistical analysis. Results The overall incidence of wide-QRS complex tachycardia was 0.02 %. Total 276 ECGs met the inclusion criteria and the ECGs were collected from 176 cases. The characteristics of ECGs were： ①rate of tachycardia： （174.76-1-31.19） bpm; ②QRS complex interval： （158.51±47.87） ms; ③QRS complex electric axis： （89.62± 112.41）°; ④according to the 2015ACC/AHA/HRS guideline1, 94 cases were diagnosed with ventricular tachycardia （53.41%） and 82 ea- ses were diagnosed with supraventricular tachycardia （46.59 %）. Among the diagnostic criteria recommended by the 2015ACC/AHA/HRS guidelines, the most common one was the ＂QRS complex in lead aVR （Vereckei algorithm）＂ with overall incidence rate of 33.11%. The second one was the ＂QRS complex in lead V1- V6 （Brugada standard）＂ with overall incidence rate of 20.45%. Conclusion Wide-QRS complex tachycardia is more likely ventricular tach- ycardia and special attention to the morphological features of QRS complex in lead aVR is recommended for differen- tial diagnosis.