aVR导联法对于鉴别诊断房颤伴室性心动过速的临床价值

Clinical value of a VR lead in diagnosis of auricular fibrillation combined with ventricular tachycardia

目的 探讨aVR导联法对于鉴别房颤伴室性心动过速的临床价值。方法 选取武汉大学人民医院收治的110例心房颤动伴连发3～5个以上畸形宽QRS波患者，分析其心电图特征，采用aVR导联法确定其为室性还是室上性。同时选取研究对象动态心电图中282处单发宽QRS波进行分析，将aVR导联法诊断室性心动过速与心室内差异性传导结果与传统方法进行对比分析。结果 aVR导联法鉴别房颤合并宽大畸形QRS波群患者，诊断室性心动过速的敏感性为88.54%，特异性为85.71%，诊断准确性为88.18%。传统方法与aVR法应用于室性心动过速诊断的符合率由高至低分别为QRS 波群呈非三相或多相波（95.40%）；有类代偿间歇（94.56%）；无长短周期 （84.52%）；QRS波群起始向量相同导联数≤7（52.30%）。传统方法与aVR导联法诊断的心室内差异性传导符合率由高到低顺序依次为有长短周期（93.02%）； QRS波群呈三相或多相波（79.06%）；QRS 波群起始向量相同导联数≥10（72.09%）；无类代偿间歇（25.00%）。结论 aVR导联法在对室性心动过速与心室内差异性传导的鉴别诊断中方便实用，但是其仍然有一定的临床限制，需与传统方法相结合进行联合诊断。

Objective To explore clinical value of aVR lead in diagnosis of atrial fibrillation combined withventricular tachycardia. Methods 110 auricular fibrillation patients with 3-5 abnormal wide QRS wave in People’s Hospital of Wuhan University were enrolled. Using aVR lead to determine whether it is ventricular tachycardiaor supraventricular tachycardia. Then diagnosis of ventricular tachycardia and results of intraventricular aberrantconduction of 282 isolated wide QRS wave in dynamic electrocardiogram of subjects by traditional method or aVRlead were compared. Results The diagnostic sensitivity of ventricular tachycardia was 88.54%; the diagnosticspecificity was 85.71%, and the diagnostic accuracy was 88.18%. The accordance rates of traditional methodand aVR lead in diagnosis of ventricular tachycardia were list in descending order: with non-triphasic wave orpolyphasic wave (95.04%), with compensatory like pause (94.56%), with no long cycle-short cycle (84.52%),with no more than 7 same leads of starting vector (52.30%). The accordance rates of traditional method and aVRlead in diagnosis of intraventricular aberrant conduction were list in descending order: with no long cycle-short cycle (93.02%), with triphasic wave or polyphasic wave (79.06%), with more than 10 same leads of starting vector(72.09%), with no compensatory like pause (25.00%). Conclusion The method of aVR lead is convenient practicalin differential diagnosis of ventricular tachycardia and intraventricular aberrant conduction, but it still has somelimitations. It needs to be used in combination with traditional method.