小儿宽QRS波群心动过速21例分析

<正>宽QRS波群心动过速是包括了一组发病机制,治疗原则均不相同的心动过速。以室性心动过速最多见,约占70%~80%,室上性心动过速伴束支阻滞(永久性和功能性)占15%~20%,室上性心动过速伴旁道前传(显性预激)占1%~5%[1]。宽QRS波群     

宽QRS波群心动过速的诊断与鉴别诊断

宽ＱＲＳ波群心动过速 (ｗｉｄｅＱＲＳｗａｖｅｔａｃｈｙｃａｒｄｉａ)一般指ＱＲＳ时间≥０．１２ｓ的心动过速 ,是临床常见的心血管急症 ,可由冠心病、心肌病、心肌炎、电解质紊乱及药物 (如奎尼丁、胺碘酮 )中毒等不同原因引起 ,亦见于健康青年人。宽ＱＲＳ波群心动过速激动的起源部位不同 ,可以是室性或室上性心动过速。其预后取决于心动过速的性质 :室性心动过速是一种严重心律失常 ;而室上性心动过速一般预后良好 ,目前广泛开展的射频消融术可使相当一部分患者获得根治［１］。现结合文献介绍宽ＱＲＳ波群心动过速的诊断和鉴别诊断…     

宽QRS波群心动过速的诊断及鉴别诊断

一、宽QRS波群心动过速的机制、类型及心电图特点1.室性心动过速(1)QRS波群宽大畸形,频率多在150～250次/min.(2)存在房室分离或有室性融合波群、窦性夺获,此点特异性高,但敏感性低.(3)胸导联QRS波群均不呈RS型.(4)当QRS波群类似右束支传导阻滞时,V_1呈单相R波或呈M型,其R波前峰>后峰,呈左突耳征(又称兔耳型)、双相波如QR、Rs、RS型,V_6呈QS、QR或RS型,其R/S<1.(5)当QRS波群类似左束支传导阻滞时,V_1有R波>30ms,R-S间期>60ms(从R波起始至S波最深点的时间),V_6呈QS、QB或RS型,R/S<1.(6)额面电轴左偏或极度右偏,尤其是如原有束支传导阻滞,则心动过速时其电轴、QRS波形有明显变化.     

宽QRS波群心动过速的诊断与鉴别诊断研究进展

宽QRS波群心动过速是临床常见的心血管急症,可见于室性心动过速和室上性心动过速。室性心动过速是一种严重的心律失常,而室上性心动过速一般预后良好。由于二者的治疗原则不同,因此及时和正确地对宽QRS波群心动过速进行鉴别诊断在临床上有十分重要的意义。现对宽QRS波群心动过速的诊断和鉴别诊断予以综述。     

宽QRS波群心动过速的鉴别诊断和处理原则

宽ＱＲＳ波群心动过速 (ｗｉｄｅｃｏｍｐｌｅｘｔａｃｈｙｃａｒｄｉａ)是指ＱＲＳ时间≥０．１２ｓ、频率＞１００次／ｍｉｎ的心动过速 ,可分为单形、多形和双向性 ,临床以单形最为常见 ,为一临床常见急症。单形性宽ＱＲＳ波群心动过速按起源部位可分为室性心动过速 (起源于Ｈｉｓ束以下 ,占８０ % )和室上性心动过速 (起源于Ｈｉｓ束分叉以上 )伴心室内传导异常 (心室内差异性传导、束支传导阻滞、旁道顺传及高血钾、抗心律失常药物、严重心肌缺血和左心室肥大引起的非特异性ＱＲＳ波群增宽 )两类。此两类鉴别诊断又常以Ｖ１导联宽ＱＲ…     

宽QRS波群心动过速一例

１病例资料患者女性,４５岁,反复发作心悸５年,加重１年入院。患者于１９９３年开始渐感心悸,无明显诱因,间断发作,持续时间数秒至数小时不等。偶伴胸闷,无胸痛、呼吸困难、晕厥等症状。曾做心电图发现“频发室性早搏”,服用“普罗帕酮、慢心律、地奥心血康”等药...     

28例宽QRS波群心动过速分析

宽QRS波群是指QRS波群宽度≥120ms，频率≥100／min的心动过速。对28例宽QRS波群心动过速病人进行分析，以探讨其病因，为临床治疗提供依据。     

宽QRS波心动过速的鉴别与诊断体会

宽QRS心动过速的诊断与鉴别,一直是心律失常诊断与治疗的重点。其诊断是否准确、及时,都将影响临床医师的处治,从而直接影响患者病情的转归。所以,准确及时诊断宽QRS心动过速对每一位心电学者工作者都是基本功,曾有2例在诊断上不准确而影响治疗,现侧重谈谈宽QRS心动过速的诊断与鉴别体会。     

宽QRS波群心动过速的心电图鉴别诊断

宽QRS波群心动过速是临床常见的心血管急症，由于起源部位不同，既有室性心动过速，又有室上性心动过速，给诊断造成一定困难。而心电图诊断宽QRS波群心动过速简单、方便、迅速，现将诊断要点报告如下。     

宽QRS波心动过速的鉴别诊断及治疗研究进展

宽QRS波心动过速是临床常见的心血管急症,可见于室性心动过速和部分室上性心动过速。室性心动过速是一种严重心律 失常,而室上性心动过速一般预后良好。由于二者的治疗原则不同,因此及时和正确地对宽QRS波心动过速进行鉴别诊断在临床 上有十分重要的意义。本文对宽QRS波心动过速的鉴别诊断和治疗原则予以综述。     

食管心电生理检查鉴别宽QRS波心动过速

目的探讨食管电生理检查在宽QRS波心动过速的诊断应用价值。方法结合心内电生理检查结论,对42例宽QRS波群心动过速（WCT）发作时的食管心电图及体表心电图诊断进行回顾性比较分析,评价食管电生理在诊断WCT中的应用价值。结果与体表心电图诊断结果相比较,食管心电图对WCT的诊断准确度更高,而误诊率、漏诊率更低。结论应用食管电生理能显著提高对WCT的诊断和鉴别诊断水平,在心律失常的治疗上也具有实用价值。     

单独用aVR导联鉴别诊断宽QRS波心动过速——附200份心电图分析

目的:应用Verecki新提出的单独运用aVR导联新法则对宽QRS 波心动过速进行鉴别诊断,评价其敏感性、特异性、阳性预测值、阴性预测值及诊断符合率.方法:选择200份经电生理检查诊断明确的宽QRS 波心动过速的心电图,采用单盲法由2位研究人员运用aVR导联新法则进行回顾性分析,并进行一致性检验后,统计aVR导联新法则每一步的诊断情况,计算敏感性、特异性、阳性预测值,阴性预测值及诊断符合率.结果:运用aVR导联新法则诊断的敏感性为97.6%,特异性为 67.7%,阳性预测值94.3%,阴性预测值为84.0%,诊断符合率为93.0%,对左室特发性室速的误诊例数为0.结论:单独运用aVR导联进行诊断具有高效准确,特别适合左室室速的鉴别诊断,适合临床应用.     

Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia.

AIMS: The Brugada criteria proposed to distinguish between regular, monomorphic wide QRS complex tachycardias (WCT) caused by supraventricular (SVT) and ventricular tachycardia (VT) have been reported to have a better sensitivity and specificity than the traditional criteria. By incorporating two new criteria, a new, simplified algorithm was devised and compared with the Brugada criteria. METHODS AND RESULTS: A total of 453 WCTs (331 VTs, 105 SVTs, 17 pre-excited tachycardias) from 287 consecutive patients with a proven electrophysiological (EP) diagnosis were prospectively analysed by two of the authors blinded to the EP diagnosis. The following criteria were analysed: (i) presence of AV dissociation; (ii) presence of an initial R wave in lead aVR; (iii) whether the morphology of the WCT correspond to bundle branch or fascicular block; (iv) estimation of initial (v(i)) and terminal (v(t)) ventricular activation velocity ratio (v(i)/v(t)) by measuring the voltage change on the ECG tracing during the initial 40 ms (v(i)) and the terminal 40 ms (v(t)) of the same bi- or multiphasic QRS complex. A v(i)/v(t) >1 was suggestive of SVT and a v(i)/v(t) 相似文献   

Current Algorithms for the Diagnosis of wide QRS Complex Tachycardias

The differential diagnosis of a regular, monomorphic wide QRS complex tachycardia (WCT) mechanism represents a great diagnostic dilemma commonly encountered by the practicing physician, which has important implications for acute arrhythmia management, further work-up, prognosis and chronic management as well. This comprehensive review discusses the causes and differential diagnosis of WCT, and since the ECG remains the cornerstone of WCT differential diagnosis, focuses on the application and diagnostic value of different ECG criteria and algorithms in this setting and also provides a practical clinical approach to patients with WCTs.     

Pseudo P waves: a cause of diagnostic confusion in wide QRS tachycardia

A patient with wide QRS tachycardia is described. His initial electrocardiogram revealed P waves in lead V1 that led to a diagnosis of supraventricular tachycardia. Subsequently, during an electrophysiology study, the tachycardia was reproduced and documented to be ventricular in origin. The P waves seen were actually part of the QRS complex and therefore pseudo P waves. The correct diagnosis of the arrhythmia allowed for more appropriate therapy for the patient. This case illustrates that pseudo P waves may be present on the surface electrocardiogram and confuse the diagnosis of wide QRS tachycardia.     

Wide QRS complex supraventricular tachycardia with negative precordial concordance: Electrocardiographic clues for Mahaim pathway with Ebstein anomaly

Ebstein's anomaly is often accompanied by either Wolff-Parkinson-White syndrome or atriofascicular Mahaim. These bypass tracts give rise to antidromic atrioventricular (AV) re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the AV node as the retrograde limb of the reentrant circuit. Since the antidromic AV reentrant tachycardia over a Mahaim fibre has a typically left bundle braunch block (LBBB) morphology, it is easy to make a misdiagnosis of supraventricular tachycardia with functional LBBB or even of ventricular tachycardia particularly in the presence of negative concordance. Some electrocardiographic clues might prevent misdiagnosis of ventricular tachycardia and inadvertent ICD implantation.     

窄QRS波群室上性心动过速时ST-T改变的临床意义

目的观察ST-T改变对窄QRS波群房室折返性心动过速(AVRT)与房室结折返性心动过速(AVNRT)的鉴别诊断及旁道初步定位的作用。方法分析150例窄QRS波群心动过速患者发作时ST段压低程度及持续时间、T波倒置等情况。结果诊断为AVNRT55例,AVRT95例。ST段压低≥2mm且持续≥100ms者AVRT组(51例,53.68%)多于AVNRT组(15例,27.27%),ST段压低幅度AVRT组(1.58±1.35mm)大于AVNRT组(0.71±0.67mm),心房间传导时间AVRT组(81.02±32.47ms)长于AVNRT组(33.30±13.56ms),差异均有显著性意义(P均<0.05)。ST段压低导联分布左侧游离壁旁道者多见于V3～V6,左后间隔和右后间隔者多见于Ⅱ、Ⅲ、aVF,右侧游离壁旁道者无特异性。结论窄QRS波群室上性心动过速时ST段改变可作为区分AVRT与AVNRT的指标,且有初步旁道定位价值。     

Griffith法Brugada法诊断宽QRS性室上性心动过速

为了解Griffith法和Brugada法诊断宽QRS性室上性心动过速（SVT）的价值，选择34例心电图表现为宽QRS心动过速者，其中SVT25例，室性心动过速（VT）9例，均经心脏电生理检查证实，采用上述两法进行了比较和综合分析。结果发现，Griffith法诊断SVT的敏感性、特异性和假阴性率分别为76％、77．8％和24％；而Brugada法的则分别为80％、88．9％和20％；两者合用时分别为84％、88．9％和16％。4例SVT为右侧旁路前传者均不符合诊断标准。认为，Griffith法和Brusada法或二者合用对SVT合并原有束支阻滞或室内差异性传导者有较高的诊断价值，而对预激旁路前传的SVT诊断价值低。