Brugada法联合Steurer法在宽QRS波心动过速鉴别诊断中的价值

The Value on Differential Diagnosis of Brugada′s Criteria With Steurer′s Criteria for Wide QRS Complex Tachycardia

为评价Brugada法联合Steurer法在宽QRS波心动过速 (WRT)鉴别诊断中的应用价值及存在的缺陷。对 1 0 1例WRT[室性心动过速 (VT) 5 8例 ,室上性心动过速 (SVT) 43例 ]进行分析。结果 :Brugada法诊断VT灵敏度、特异度、准确性分别为 85 .7%、89.5 %、87.1 % ;联合Steurer法后灵敏度、特异度、准确性分别升至 91 .5 %、90 .5 %、91 .1 %。进一步分析显示 :Brugada法对器质性原因所致VT、右束支阻滞型 (RBBB)特发性VT(IVT)、SVT伴室内差异性传导 (AC)或原有单侧束支阻滞 (BBB)者诊断符合率高 ( 95 .8%～ 1 0 0 .0 % ) ;对左束支阻滞型 (LBBB)特发性VT、SVT伴原有双支阻滞、心肌坏死或心肌梗死伴宽QRS波SVT及预激综合征伴旁道前传型SVT(WPW SVT)诊断的符合率低 ( 0～ 5 0 .0 % )。联合Steurer法可使WPW伴旁道前传型SVT得以明确诊断 ,但对前三者无鉴别意义 ,故不适合在前三者中应用。结论 :Brugada法联合Steurer法能提高WPW伴旁道前传型SVT的鉴别能力 ,是目前鉴别WRT的重要方法。

To explore the value of Brugada's criteria with Steurer′s criteria for the differential diagnosis of wide QRS complex tachycardia, one hundred and one patients, 58 with ventricular tachycardia(VT), 43 with supraventricular(SVT), were studied retrospectively by Brugada's criteria with Steurer′s criteria. Results: The sensitivity, specificity and accuracy of Brugada′s criteria with Steurer′s criteria were 91.5%,90.5% and 91.1%; they were slightly higher than those of Brugada′s criteria(85.7%,89.5% and 87.1%). Further analysis showed: Brugada′s criteria with Steurer′s criteria had a high coincidence rate for diagnosis of VT with organic heart disease,SVT with intraventricular aberrant conduction or bundle branch block(BBB) and Wolff Parkinson White syndrome(WPW) with SVT of bypass anterograde conduction. But they were low coincidence rate for diagnosis of idiopathic ventricular tachycardia(IVT) with left BBB, SVT with bifascicular block or myocardial necrosis and myocardial infarction . Conclusion: Brugada′s criteria with Steurer's criteria are effective for differential diagnosis of VT with organic heart disease, IVT with right BBB and SVT with intraventricular aberrant conduction, SVT BBB and WPW SVT. But they have little value to diagnosis IVT of LBBB and SVT with bifascicular block or myocardial necrosis .