单导联鉴别宽QRS波心动过速的临床分析  

Two algorithm using lead Ⅱ or lead aVR for differential diagnosis of wide QRS complex tachycardias

作　　者：王德国[1] 王新[1] 王安才[1] 张凤祥[2] 闫银川[2] 陈红武[2] 曹克将[2] 

机构地区：[1]皖南医学院附属弋矶山医院,241001 [2]南京医科大学附属第一临床医学院,210029

出　　处：《临床心电学杂志》2010年第6期413-415,共3页Journal of Clinical Electrocardiology

摘　　要：目的分析单导联心电图对宽QRS波心动过速(WCT)的鉴别价值。方法对经心内电生理检查或射频消融治疗而明确诊断的WCT患者,研究aVR导联四步法和Ⅱ导联R波峰时限(RWPT)测定对WCT诊断的准确率。结果 149例WCT患者中,107例室性心动过速(VT),42例室上性心动过速(SVT)。应用aVR导联四步法正确诊断136例,准确率91.27%,敏感性95.33%,特异性80.95%,阳性预测值92.73%,阴性预测值87.18%;应用Ⅱ导联RWPT法,124例得到正确诊断,准确率83.22%,敏感性为80.05%,特异性为78.57%,阳性预测值91%,阴性预测值67.35%,其中左室特发性室速(ILVT)和房扑误诊较高。结论 aVR导联四步法和Ⅱ导联RWPT均可正确鉴别大部分WCT,但对ILVT与房扑存在明显的误诊。Objective To determine the value of ECG lead Ⅱ or lead aVR in differentiating ventricular tachycardia（VT） from supraventricular tachycardia （SVT） in patients with wide QRS complex tachycardia. Methods Vereckei＇s aVR algorithm and RWPT duration at lead Ⅱ were used to evaluate one hundred forty nine ECGs showing wide QRS complex tachycardias by two cardiologists blinded to the diagnosis. The results between VT and SVT were compared with the findings of electrophysiologic study used as the gold standard. Results The sensitivity and specificity of aVR algorithm were 95.33% and 80.95%. The positive and negative predictive value were 92.73% and 87.18%. The diagnose accuracy was 91.27%. As a contrast,the sensitivity,specificity,accuracy and positive and negative predictive value of lead Ⅱ methods were 80.05%,78.57%,83.22%,91% and 67.35%,respectively. Misdiagnosis rate was high in left idiopathic ventrieular tachycardia （LIVT） and atrial flutter（AFL）.Conclusion Single lead Ⅱ and lead aVR algorithms are suitable to differential diagnoses WCT with considerable accuracy. However,lead Ⅱ algorithm seems unsuitable to apply in LIVT and AFL patients.

关 键 词：心动过速 心电图 鉴别诊断 

分 类 号：R541.7[医药卫生—心血管疾病]