窄QRS波心动过速的远程心电诊断

The remote electrocardiogram diagnosis of narrow-QRS complex tachycardia

目的探讨窄QRS波心动过速的形成机制,以及体表心电图对形成机制的诊断价值。方法 2016年1月1日至2017年12月31日上海交通大学远程心电诊断中心所有数字化心电图数据入选统计。结果①窄QRS波心动过速,共计心电图记录1184人次,采自于941例病例,最终713例入选统计。②按有无窦性或其他室上性异位心律心电图对照,将病例分为'有对照组'(316例)和'无对照组'(397例)。有对照组,58.5%被判断有P波,无对照组,44.8%被判断疑似有P波,有对照组更易判断有无P波(P<0.001)。③有对照组和无对照组,在有P波者中,RP间期<PR间期者多见,且RP间期<90 ms多见,提示窄QRS波心动过速主要由房室结折返性心动过速构成。结论窄QRS波心动过速中,主要形成机制是房室结内折返;记录体表心电图,能对窄QRS波心动过速的形成机制作出初步的诊断。

Objective To investigate the mechanisms of narrow-QRS complex tachycardia and the diagnostic value of body surface electrocardiogram(ECG).Method Total digital ECG recorded from January 1 st,2016 to December 31 st,2017 in Shanghai Jiaotong University remote ECG diagnosis center were admitted into statistics.Results①Total 1184 ECGs met the diagnosis of'narrow-QRS complex tachycardia'and the ECGs were collected from 941 cases.Eventually,713 cases were enrolled into statistics.②These cases were divided into'with ECG for reference group'(316 cases)and'without ECG for reference group'(397 cases)according to their sinus or other supraventricular rhythm were recorded in ECG or not.Among'with ECG for reference group',P-wave can be recognized in 58.5%.While,'without ECG for reference group',suspected P-wave can be recognized in 44.8%.With ECG for reference,the P-wave can be recognized more easily(P<0.001).③In the cases with recognized P-wave,RP interval<PR interval was more common than RP interval≥PR interval,further more RP interval<90 ms was more common than RP interval≥90 ms.The results suggested that the main component of narrow-QRS complex tachycardia is atrioventricular nodal reentrant tachycardia.Conclusion The main mechanisms of narrow-QRS complex tachycardia is reentrance within atrioventricular nodal.Surface electrocardiogram can make a preliminary diagnosis of the mechanism of narrow-QRS complex tachycardia.