aVR导联法在心房颤动伴宽QRS波群心动过速鉴别诊断中的应用

Application of aVR Lead Method in Differential Diagnosis of Atrial Fibrillation with Wide QRS Complex Tachycardia

目的研究aVR导联法在心房颤动伴宽QRS波群心动过速鉴别诊断中的应用。方法选取2019年8月-2021年7月在我院诊治的78例心房颤动伴宽QRS波群(278处)患者为研究对象,以传统方法为金标准,观察aVR导联法对室性和室内差异性传导的诊断、心动过速的诊断效能(敏感度、特异性、准确率)以及室性心动过速和室内差异性传导心电图特征。结果78例患者中室性心动过速者60例,室内差异传导者18例;诊断室性心动过速敏感度为88.23%、特异度为为80.00%、准确率为89.65%。aVR导联法诊断室性QRS波长短周期、QRS波群三相或多相、QRS波起始向量相同导联数≥10的符合率均低于室内差异性传导QRS波,QRS波起始向量相同导联数≤7符合率高于室内差异性传导QRS波(P<0.05);室性心动过速QRS波群呈非三相或多相波、有类代偿间歇、无长短周期检出率、、QRS时间均高于室内差异性传导QRS波(P<0.05)。结论aVR导联法在心房颤动伴宽QRS波群心动过速鉴别诊断中具有较高的价值,QRS波群呈非三相或多相波、有类代偿间歇、无长短周期参数可为鉴别诊断提供参考依据。

Objective To study the application of aVR lead method in the differential diagnosis of atrial fibrillation with wide QRS complex tachycardia.Methods A total of 78 patients with atrial fibrillation and wide QRS complex(278)places diagnosed and treated in our hospital from August 2019 to July 2021 were selected as the research objects.The traditional method was used as the gold standard to observe the diagnosis of ventricular and intraventricular differential conduction by aVR lead method,the diagnostic efficacy(sensitivity,specificity and accuracy)of tachycardia,and the ECG characteristics of ventricular tachycardia and intraventricular differential conduction.Results Among the 78 patients,there were 60 cases of ventricular tachycardia and 18 cases of indoor differential conduction.The sensitivity,specificity and accuracy of diagnosing ventricular tachycardia were 88.23%,80.00%and 89.65%,respectively.The coincidence rate of aVR lead method in the diagnosis of ventricular QRS wavelength short cycle,QRS wave group three-phase or multi-phase,QRS wave initiation vector with the same lead number≥10 was lower than that of indoor differential conduction QRS wave,and the coincidence rate of QRS wave initiation vector with the same lead number≤7 was higher than that of indoor differential conduction QRS wave(P<0.05).The QRS wave group of ventricular tachycardia showed non-three-phase or multi-phase wave,quasi-compensatory intermittent,no long-term and short-term cycle detection rate,and QRS time were higher than the indoor differential conduction QRS wave(P<0.05).Conclusion The aVR lead method has a high value in the differential diagnosis of atrial fibrillation with wide QRS complex tachycardia.The QRS wave group is non-three-phase or multi-phase wave,with quasi-compensatory intermittent,and no long-term and short-term cycle parameters can provide reference for differential diagnosis.