肢体导联反向法和室性心动过速积分法在鉴别预激性心动过速中的临床价值

Clinical value of opposing QRS complex on limb leads criteria and ventricular tachycardia score in identifying pre-excited tachycardia

目的探讨肢体导联反向法和室性心动过速(VT)积分法在鉴别预激性心动过速中的临床价值。方法回顾性分析2013年1月至2021年6月首都医科大学附属北京友谊医院经心内电生理确诊为预激性心动过速的住院患者18例,收集患者发作时的12导联心电图,分别采用肢体导联反向法和VT积分法进行评分。采用χ2检验比较二者诊断预激性心动过速的特异度差异,并分析2种流程诊断预激性心动过速不同类型和不同旁路位置中的特异度。结果18例患者中,肢体导联反向法诊断的真阳性11例,特异度为38.89%;VT积分法积分≥2分、≥3分诊断预激性心动过速的特异度分别为55.56%、100.00%。肢体导联反向法与VT积分法积分≥2分诊断预激性心动过速的特异度比较,差异无统计学意义(P>0.05);肢体导联反向法与VT积分法积分≥3分的特异度比较,差异有统计学意义(P<0.05)。2种诊断流程对不同类型和旁路位置预激性心动过速诊断的特异度差异无统计学意义(P>0.05)。结论VT积分法积分≥3分可区分预激性心动过速和VT,肢体导联反向法和VT积分法≥2分则不能区分。

Objective To compare the clinical value of opposing QRS complex on limb leads(OQL)criteria and ventricular tachycardia(VT)score in identifying pre-excited tachycardia.Methods Twelve-lead electrocardiograph results were obtained from 18 patients at pre-excited tachycardia attacking stage who were diagnosed by electrophysiology.Pre-excited tachycardia was scored based on the OQL criteria and the VT score.The specificities of OQL criteria and VT score(≥2 points and≥3 points)in identifying pre-excited tachycardia were compared by chi-square test.The specificities of the two modalities in different preexcitation types and different bypass positions were analyzed.Results The specificity of OQL criteria for patients with pre-excited tachycardia was 38.89%.The specificity of VT score(≥2 points and≥3 points)for patients with pre-excited tachycardia were 55.56%and 100.00%,respectively.Comparing the results of the OQL criteria with the VT score≥2 points,there was no statistical difference in the two groups(P>0.05).Comparing the results of the OQL criteria with the VT score≥3 points,the difference was statistically significant(P<0.05).There was no significant difference in the specificities of the two modalities in different pre-excitation types and different bypass positions(P>0.05).Conclusion VT score≥3 points can completely identify pre-excited tachycardia and VT.The OQL criteria and VT score≥2 points cannot completely distinguish pre-excited tachycardia from VT.