心电图伪差误诊断为快速性室性心律失常的分析  

Analytical study of electrocardiographic artefact mimicking rapid ventricular arrythmia

作　　者：颜清 仇悦 张凤祥[1] 居维竹[1] 杨刚[1] 顾凯[1] 施姣姣[1] 刘海雷 王子盾[1] 郦明芳[1] 陈红武[1] 陈明龙[1] YAN Qing;QIU Yue;ZHANG Feng-xiang;JU Wei-zhu;YANG Gang;GU Kai;SHI Jiao-jiao;LIU Hai-lei;WANG Zi-dun;LI Ming-fang;CHEN Hong-wu;CHEN Ming-long(Division of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院心血管科,江苏南京210029

出　　处：《中国心脏起搏与心电生理杂志》2022年第3期218-222,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 分析室性心律失常心电图伪差特征,试图为临床鉴别诊断提供帮助。方法 收集误诊为快速性室性心律失常来院就诊的8例伪差心电图,分析伪差启动及终止特征,伪差发生时有无QRS波征象。结果 8例患者,3例误诊为快速性室性心动过速,5例为心室扑动。所有患者伪差中均可找到正常的QRS波征象;3例误诊为心室扑动患者的伪差信号起始于QRS波群起始部,此时为心室绝对不应期,据此可以排除心律失常;3例伪差终止时未观察到明显的ST-T波形亦可排除心室扑动。Objective To analyze the characteristics of electrocardiographic(ECG) artifacts, hoping to provide some clues to differential diagnosis between artefact and arrythmia. Methods The characteristics of ECG artifacts were documented in 8 patients, which were misdiagnosed as rapid ventricular arrythmias at the local hospital. The beginning and the terminal of artefact signals were analyzed, the regular QRS signal during the artefact period was also analyzed. Results Eight patients were enrolled in this study, 3 patients were misdiagnosed as rapid ventricular tachycardia, 5 cases were ventricular flutter. The sign of normal QRS waves can be identified in all cases. In the 3 cases misdiagnosed as ventricular flutter, the signals of artefacts were spontaneously onset from the beginning of QRS waves, which belonged to ventricular absolutely refractory period. According to this phenomenon, ventricular arrhythmia can be excluded. 3 cases were excluded because there were no ST-T waves at the terminal of the artefact.

关 键 词：心血管病学 心电图伪差 心律失常 室性心动过速 心室扑动 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]