Ⅱ型Brugada心电图改变与IRBBB的鉴别

The Discrimination Between Brugada Type Ⅱ ECG Pattern and Incomplete Right Brunch Bundle Block

目的Ⅱ型Brugada综合征和不完全性右束支传导阻滞(IRBBB)的心电图表现类似,V1导联均呈r Sr’型,但是它们的发病机制和治疗方法、预后完全不同,本研究试图发现二者在心电图指标的不同,以期减少Ⅱ型Brugada综合征早期就诊时的漏诊和误诊。方法选择心电图诊断为IRBBB的心电图146例,根据ST段形态将其分为:(1)ST段抬高组,分为两个亚组:①马鞍形ST段抬高组,也即Ⅱ型Brugada综合征样心电图改变(21例);②非马鞍形ST段抬高组,也即IRBBB伴ST段抬高,(28例);(2)非ST段抬高组,也即IRBBB不伴ST段抬高(97例),观察V1/V2S波上升肢与r’(或J波)下降肢之间的夹角(β角),经r’顶点(或J波顶点)的垂直线与r’下降肢(或J波下降肢)之间的夹角(α角)以及β角与基线形成的基底的长度,与β角顶点5mm垂直线相交的基底线的长度。结果①ST段抬高组α角以及β角显著大于无ST段抬高组(17.9±9.2 vs 15.5±7.1,p<0.01,23.3±10.3 vs 20.8±9.0,p<0.05);②Ⅱ型Brugada心电图样改变组α角以及β角显著大于IRBBB伴ST段抬高组,(20.7±10.1 vs 15.8±7.2,p<0.05,25.6±11.3 vs 20.8±9.0,p<0.05)。结论 ST段抬高的形态与α角以及β角有关,马鞍型的ST段抬高的α角以及β角明显增大,可以此作为诊断和鉴别诊断Ⅱ型Brugada样心电图改变与不完全性右束支阻滞的客观依据之一。

Brugada Type Ⅱ ECG is featured with J wave and saddled-shaped ST segment elevation, that is often confused with the incomplete right bundle brunch block(IRBBB)which is also has a r’ wave and ST segment elevation. Objective Brugada Type Ⅱ ECG pattern and IRBBB have quite different treatment and recover result, we try to find some values for discriminating between them. Methods 146 patients who were diagnosed as IRBBB with V1 r Sr’ shape in the hospital were selected, they were divided in 2 groups according to the ST segment. Group A: ST segment elevation group, which was divided into 2 subgroups: ①Type Ⅱ Brugada ECG pattern(saddled-shaped ST-segment elevation, 21 cases), ② IRBBB with ST-segment elevation( non saddled-shaped ST-segment elevation,28 cases). Group B: All patients without ST segment elevation,97 cases.Values were measured: ① α angle, the angle between the vertical line and downslope of r’wave. ② β angle,between the upslope of S-wave and downslope of r’wave. Results The mean values of α and β angle in ST segment elevation group were significantly bigger than in non-ST segment elevation group,(17.9±9.2 vs 15.5±7.1,p<0.01, 23.3±10.3 vs 20.8±9.0, p<0.05). Type Ⅱ Brugada ECG pattern were significantly bigger than IRBBB with ST-segment elevation(20.7±10.1 vs 15.8±7.2, p<0.05, 25.6±11.3 vs 20.8±9.0, p<0.05). Conclusions Saddled-ST segment elevation could increase α and β angle in V1/V2, that may be a method for discriminating between Brugada Type Ⅱ ECG pattern and IRBBB.