Electrocardiographic findings in leads V_(3R) to V_(5R) in patients with a slurred or notched S wave in lead V_1

Background Right bundle branch block （RBBB） may present as slurred or notched S wave in lead V1. However, slurred or notched S wave may also represent slow conduction in the myocardium. Methods We retrospectively analyzed the QRS patterns in leads VgR to V5R in 7 patients with a slurred or notched S wave in lead V1. Results In the leads V3R to VSR, 6 patients showed incomplete or complete RBBB and 1 patient slurred or notched S wave. Conclusions In the majority of ECGs in a small patient series with slurred or notched S wave in lead V1, QRS morphology indicating incomplete or complete RBBB was present in leads V3R to VSR. A finding of fragmented QRS in these leads may indicate slow conduction in the myocardium.

基于心电图V_1及avL导联的窄QRS波群心动过速鉴别诊断流程及应用评价

目的观察分析以V1导联假性r'波合并avL导联QRS波群终末切迹为基础的鉴别诊断流程,并评价其对窄QRS波群心动过速的鉴别作用。方法随机选取"阵发性室上性心动过速"且成功行射频消融治疗患者277例,观察其中165例患者(AVNRT组90例,AVRT组75例)窦性心律及术中诱发心动过速时的体表心电图,以鉴别指标的敏感性、特异性、阳性预测值及阴性预测值为依据制定诊断流程;对其余112例患者心电图进行盲法的前瞻性研究,评价其鉴别诊断的准确性和应用价值。结果两组V1导联假性r'波并avL导联终末切迹,下壁导联假性q波或假性s波或原有的s波消失,有可识p波且RP间期>70 ms,avR导联ST段抬高,以及胸前导联ST段下移≥0.2 mV等5个鉴别指标的差异有统计学意义(P<0.005)。以之制定的诊断流程鉴别AVNRT及AVRT的准确率分别为91.38%和88.89%。结论以心电图V1导联假性r'波合并avL导联终末切迹为基础的鉴别诊断流程,可以更加准确地判断窄QRS波心动过速的机制。