New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia
New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia
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DOI：
10.1016/j.hrthm.2007.09.020
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发表时间：
2008-01-01
期刊：
影响因子：
5.5
通讯作者：
Miller, John M.
中科院分区：
文献类型：
--
作者：
Vereckei, Andras;Duray, Gabor;Miller, John M.
背景：我们最近报道了一种ECG算法用于常规宽QRS复杂心动过速的鉴别诊断，优于Brugada算法。目的：通过省去复杂的形态学标准，将分析限制在导联aVR上，进一步简化算法。方法本研究对313例确诊的483例宽QRS复合心动过速[351例室性心动过速（vt）， 112例室上性心动过速（svt）， 20例预激性心动过速]进行前瞻性分析，其中两位作者对诊断不知情。分析导联aVR(1)是否存在初始R波，(2)初始R波或q波的宽度约为40 ms， (3) QRS复合物的初始下冲程缺口，以及(4)心室激活-速度比(v(i)/v(t))， QRS复合物初始（v(i)）和末端（v(t)） 40 ms时记录的垂直偏移（毫伏）。当出现1 - 3项标准中的任何一项时，诊断为VT；如果不存在，则分析下一个标准。在步骤4中，v(i)/v(t) > 1建议SVT， v(i)/v(t)
BACKGROUND We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm.OBJECTIVE The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR.METHODS In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave > 40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (v(i)/v(t)), the vertical excursion (in millivolts) recorded during the initial (v(i)) and terminal (v(t)) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, v(i)/v(t) > 1 suggested SVT, and v(i)/v(t)