ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: Practical aspects for the immediate care setting
ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: Practical aspects for the immediate care setting
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DOI：
10.1111/j.1540-8159.1995.tb04647.x
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发表时间：
1995-12-01
影响因子：
1.8
通讯作者：
Scheinman, MM
中科院分区：
文献类型：
--
作者：
Drew, BJ;Scheinman, MM
为重新评价室上性心动过速(SVT)伴异常传导与室性心动过速(VT)的心电图鉴别标准，对133例接受有创电生理(EP)检查的患者记录到133个宽QRS波。体表心电图导联(标准12导联和MCL导联)与EP记录进行比较，为正确诊断提供标准。6项研究的标准被合并，以选择公认的对SVT或VT具有高度特异性的QRS形态(特异性，90%)。修改了一些形态标准，以简化对即时护理环境的分析。结果：12导联心电图对室性心动过速与室性心动过速的鉴别诊断有价值，但误诊或漏诊13例(10%)。在40%的VT患者中，MCL(1)导联记录到的QRS形态明显不同于V-1导联，诊断上低于V-1导联。大多数已建立的标准对诊断具有高度的特异性，但作为单独的标准不是很敏感。QRS波宽0.14秒或V-1导联单相R波型对诊断室性心动过速均无价值。结论：在鉴别异常传导的室上性心动过速与室性心动过速时：(1)12导联心电图虽有价值，但约1/10宽的QRS心动过速的鉴别；(2)心动过速，190次/分钟通常不能提供明确的诊断标准；(3)需要多导联才能准确评估QRS的宽度、是否有房室分离或VA传导阻滞、QRS轴和形态标准；(4)在使用VT的形态标准时，不能用MCL(1)导联代替V-1。
To reevaluate ECG criteria for distinguishing supraventricular tachycardia (SVT) with aberrant conduction from ventricular tachycardia (VT), 133 wide QRS tachycardias were recorded in patients undergoing invasive electrophysiological (EP) study. Surface ECG leads (standard 12-lead and MCL leads) were compared to EP recordings to provide a standard for correct diagnosis. Criteria from six studies were pooled to select QRS morphology agreed to be highly specific for SVT or VT (specificity, 90%). Some morphological criteria were modified to simplify analysis for the immediate care setting. Results: Although the 12-lead ECG was useful in distinguishing aberrancy from VT, 13 tachycardias (10%) were misdiagnosed or could not be diagnosed. The MCL(1) lead recorded clearly different QRS morphology than lead V-1 in 40% of VT cases and was diagnostically inferior to V-1. Most established criteria were highly specific for a diagnosis, but not very sensitive as individual criteria. Neither a QRS width of > 0.14 seconds nor a monophasic R wave pattern in lead V-1 were valuable in diagnosing VT. Conclusions: In distinguishing SVT with aberrant conduction from VT: (1) Although the 12-lead ECG is valuable, about 1 in 10 wide QRS tachycardias differentiation; (2) tachycardias, > 190 beats/min often do not exhibit unequivocal criteria with which to make a certain diagnosis; (3) multiple leads are required for accurate assessment of QRS width, presence of AV dissociation or VA block, QRS axis, and morphological criteria; and (4) the MCL(1) lead cannot be substituted for V-1 in the use of morphological criteria for VT.