aVR导联法对于鉴别诊断房颤伴室性心动过速的临床价值
|
摘要
目的探讨a VR导联法对于鉴别房颤伴室性心动过速的临床价值。方法选取武汉大学人民医院收治的110例心房颤动伴连发3~5个以上畸形宽QRS波患者,分析其心电图特征,采用a VR导联法确定其为室性还是室上性。同时选取研究对象动态心电图中282处单发宽QRS波进行分析,将a VR导联法诊断室性心动过速与心室内差异性传导结果与传统方法进行对比分析。结果 a VR导联法鉴别房颤合并宽大畸形QRS波群患者,诊断室性心动过速的敏感性为88.54%,特异性为85.71%,诊断准确性为88.18%。传统方法与a VR法应用于室性心动过速诊断的符合率由高至低分别为QRS波群呈非三相或多相波(95.40%);有类代偿间歇(94.56%);无长短周期(84.52%);QRS波群起始向量相同导联数≤7(52.30%)。传统方法与a VR导联法诊断的心室内差异性传导符合率由高到低顺序依次为有长短周期(93.02%);QRS波群呈三相或多相波(79.06%);QRS波群起始向量相同导联数≥10(72.09%);无类代偿间歇(25.00%)。结论 a VR导联法在对室性心动过速与心室内差异性传导的鉴别诊断中方便实用,但是其仍然有一定的临床限制,需与传统方法相结合进行联合诊断。
Objective To explore clinical value of a VR lead in diagnosis of atrial fibrillation combined with ventricular tachycardia. Methods 110 auricular fibrillation patients with 3-5 abnormal wide QRS wave in People's Hospital of Wuhan University were enrolled. Using a VR lead to determine whether it is ventricular tachycardia or supraventricular tachycardia. Then diagnosis of ventricular tachycardia and results of intraventricular aberrant conduction of 282 isolated wide QRS wave in dynamic electrocardiogram of subjects by traditional method or a VR lead were compared. Results The diagnostic sensitivity of ventricular tachycardia was 88.54%; the diagnostic specificity was 85.71%, and the diagnostic accuracy was 88.18%. The accordance rates of traditional method and a VR lead in diagnosis of ventricular tachycardia were list in descending order: with non-triphasic wave or polyphasic wave(95.04%), with compensatory like pause(94.56%), with no long cycle-short cycle(84.52%), with no more than 7 same leads of starting vector(52.30%). The accordance rates of traditional method and a VR lead in diagnosis of intraventricular aberrant conduction were list in descending order: with no long cycle-shortcycle(93.02%), with triphasic wave or polyphasic wave(79.06%), with more than 10 same leads of starting vector(72.09%), with no compensatory like pause(25.00%). Conclusion The method of a VR lead is convenient practical in differential diagnosis of ventricular tachycardia and intraventricular aberrant conduction, but it still has some limitations. It needs to be used in combination with traditional method.Keywords
Objective To explore clinical value of a VR lead in diagnosis of atrial fibrillation combined with ventricular tachycardia. Methods 110 auricular fibrillation patients with 3-5 abnormal wide QRS wave in People's Hospital of Wuhan University were enrolled. Using a VR lead to determine whether it is ventricular tachycardia or supraventricular tachycardia. Then diagnosis of ventricular tachycardia and results of intraventricular aberrant conduction of 282 isolated wide QRS wave in dynamic electrocardiogram of subjects by traditional method or a VR lead were compared. Results The diagnostic sensitivity of ventricular tachycardia was 88.54%; the diagnostic specificity was 85.71%, and the diagnostic accuracy was 88.18%. The accordance rates of traditional method and a VR lead in diagnosis of ventricular tachycardia were list in descending order: with non-triphasic wave or polyphasic wave(95.04%), with compensatory like pause(94.56%), with no long cycle-short cycle(84.52%), with no more than 7 same leads of starting vector(52.30%). The accordance rates of traditional method and a VR lead in diagnosis of intraventricular aberrant conduction were list in descending order: with no long cycle-shortcycle(93.02%), with triphasic wave or polyphasic wave(79.06%), with more than 10 same leads of starting vector(72.09%), with no compensatory like pause(25.00%). Conclusion The method of a VR lead is convenient practical in differential diagnosis of ventricular tachycardia and intraventricular aberrant conduction, but it still has some limitations. It needs to be used in combination with traditional method.Keywords
引文
[1]李方洁,向晋涛.心电散点图呈现的房室结功能不应期及对宽QRS波的鉴别[J].中国心脏起搏与心电生理杂志,2011,25(1):16-9.
[2]谢利剑,王健怡,沈捷,等.a VR导联法在儿童室性心动过速鉴别诊断中的价值[J].临床儿科杂志,2012,30(7):670-2.
[3]翁凌云,罗红燕,陶国英,等.Vereckei av R导联法对室性期前收缩的诊断价值[J].中国全科医学,2010,13(6):636.
[4]梁飞腾,朱瑞珍.av R导联法与Vi/Vt比值联合应用对宽QRS波群心动过速的诊断价值[J].中国医药指南,2012,10(21):204-5.
[5]代雯雅.宽QRS波心动过速的诊治进展[J].心血管病学进展,2014,35(4):447-51.
[6]刘志红,王晓燕,籍振国,等.心电图a VR导联ST段变化对急性冠脉综合征患者临床风险的预测价值研究[J].中国全科医学,2015,(15):1733-7.
[7]施艳红,张绪国,周建华,等.窄QRS波群性室性心动过速误诊原因分析[J].医学信息(中旬刊),2011,24(3):935-6.
[8]林涛,马依彤,木胡牙提,等.Vereckei四步法在宽QRS波心动过速鉴别诊断中的应用[J].中国循环杂志,2010,25(1):47-50.
[9]林丽萍,王荷特,潘炳林,等.Vereckei新四步法在房颤伴宽QRS波群中的鉴别诊断意义[J].实用医学杂志,2010,26(18):3379-80.
[10]吴龙梅,崔俊玉,李俊峡,等.Vereckei新四步法对宽QRS波室性心动过速的诊断价值[J].中国循证心血管医学杂志,2013,(6):622-3.
[2]谢利剑,王健怡,沈捷,等.a VR导联法在儿童室性心动过速鉴别诊断中的价值[J].临床儿科杂志,2012,30(7):670-2.
[3]翁凌云,罗红燕,陶国英,等.Vereckei av R导联法对室性期前收缩的诊断价值[J].中国全科医学,2010,13(6):636.
[4]梁飞腾,朱瑞珍.av R导联法与Vi/Vt比值联合应用对宽QRS波群心动过速的诊断价值[J].中国医药指南,2012,10(21):204-5.
[5]代雯雅.宽QRS波心动过速的诊治进展[J].心血管病学进展,2014,35(4):447-51.
[6]刘志红,王晓燕,籍振国,等.心电图a VR导联ST段变化对急性冠脉综合征患者临床风险的预测价值研究[J].中国全科医学,2015,(15):1733-7.
[7]施艳红,张绪国,周建华,等.窄QRS波群性室性心动过速误诊原因分析[J].医学信息(中旬刊),2011,24(3):935-6.
[8]林涛,马依彤,木胡牙提,等.Vereckei四步法在宽QRS波心动过速鉴别诊断中的应用[J].中国循环杂志,2010,25(1):47-50.
[9]林丽萍,王荷特,潘炳林,等.Vereckei新四步法在房颤伴宽QRS波群中的鉴别诊断意义[J].实用医学杂志,2010,26(18):3379-80.
[10]吴龙梅,崔俊玉,李俊峡,等.Vereckei新四步法对宽QRS波室性心动过速的诊断价值[J].中国循证心血管医学杂志,2013,(6):622-3.