心电图新流程鉴别阵发性室上性心动过速类型  

A new electrocardiogram algorithm to differentiate the type of paraxysmal supraventricular tachycardia

作　　者：曹园园 吴智鸿[1] 刘振江[1] 刘启明[1] CAO Yuanyuan;WU Zhihong;LIU Zhenjiang;LIU Qiming(Department of Cardiovascular Medicine,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心血管内科,长沙410011

出　　处：《临床与病理杂志》2024年第8期1121-1125,共5页Journal of Clinical and Pathological Research

摘　　要：目的:通过心电图准确识别阵发性室上性心动过速类型仍存在困难,本研究旨在整合发作时多种心电图特征,形成新的心电图诊断流程,评价该流程对鉴别阵发性室上性心动过速类型的作用。方法:通过前期研究和文献分析,形成新的心电图诊断四步流程。筛选2021年1月至2023年12月在中南大学湘雅二医院心血管内科住院的阵发性室上性心动过速患者505例,由2位心内科医师按新的心电图诊断四步流程分析心电图,并作出诊断分型。结果:通过该心电图诊断流程正确识别出阵发性室上性心动过速类型的心电图共454份,符合率为89.9%。该方法从阵发性室上性心动过速患者中识别出房室结折返性心动过速(atrioventricular node reentrant tachycardia,AVNRT)的灵敏度为89.6%,特异度为90.5%,阳性预测值为95.0%,阴性预测值为81.4%。受试者操作特征(receiver operating characteristic,ROC)曲线下面积达0.90。2位医师的诊断结果一致性达98.6%。结论:该心电图新流程用于鉴别AVNRT和房室折返性心动过速(atrioventricular reciprocating tachycardia,AVRT)有较高的敏感度和特异性,是合适的鉴别AVNRT和AVRT的方法。Objective:Accurately identifying types of paroxysmal supraventricular tachycardia(PSVT)through electrocardiogram(ECG)remains challenging.This study aims to develop a new ECG diagnostic algorithm that integrates multiple ECG characteristics observed during episodes and to evaluate its efficacy in distinguishing PSVT types.Methods:A new four-step ECG diagnostic algorithm was established through preliminary research and literature review.A total of 505 patients with PSVT hospitalized at the Department of Cardiology,Second Xiangya Hospital of Central South University from January 2021 to December 2023 were selected.Two cardiologists analyzed the ECGs according to this new four-step diagnostic algorithm and classified the PSVT types.Results:The algorithm correctly identified PSVT types in 454 ECGs,with an accuracy rate of 89.9%.The sensitivity and specificity of identifying atrioventricular node reentrant tachycardia(AVNRT)were 89.6%and 90.5%,respectively,with a positive predictive value of 95.0%and a negative predictive value of 81.4%.The area under the receiver operating characteristic(ROC)curve was 0.90.The diagnostic consistency between the 2 cardiologists was 98.6%.Conclusion:This new ECG algorithm provides high sensitivity and specificity for differentiating AVNRT from atrioventricular reciprocating tachycardia(AVRT),making it an effective method for ECG-based differentiation of AVNRT and AVRT.

关 键 词：阵发性室上性心动过速 房室结折返性心动过速 房室折返性心动过速 心电图鉴别诊断 

分 类 号：R541.71[医药卫生—心血管疾病] R540.41[医药卫生—内科学]