CAJ | 학술논문

目的：探讨心电图Ⅱ导联R波第1峰时限( RWPT)分布特征及其在宽QRS波心动过速鉴别诊断中的应用价值。方法入选因阵发性室上性心动过速于2013年9月至2014年3月在福建省立医院、福建省心血管病研究所心电生理研究室行射频消融术患者32例,男18例,女14例,年龄12~68(46．1±13．4)岁。32个病例164份心室不同部位起搏12导联心电图,2名心电工作者双盲法手工测量RWPT,并比较不同部位心室起搏RWPT差异。结果164份起搏心电图中152份(92．7%)RWPT≥50 ms,12例(7．3%) RWPT<50 ms均位于左心室游离壁、左心室基底部起搏组；右心室高位间隔组(91．4±13．6)ms、右心室中位间隔组(80．2±12．8)ms具有较高RWPT,左心室心底部组(54．6±15．5)ms、左心室游离壁组(51．3±9．5) ms, RWPT 较低( P<0．05)。结论心电图Ⅱ导联第1峰时限 RWPT≥50 ms是宽QRS波心动过速判定为室性心律失常的简单、快捷、有效指标,特别对于右心室间隔部、流入道起源室性心动过速(室速),而对于左心室心底部、左侧游离壁起源室性心动过速鉴别敏感性较差。
목적：탐토심전도Ⅱ도련R파제1봉시한( RWPT)분포특정급기재관QRS파심동과속감별진단중적응용개치。방법입선인진발성실상성심동과속우2013년9월지2014년3월재복건성립의원、복건성심혈관병연구소심전생리연구실행사빈소융술환자32례,남18례,녀14례,년령12~68(46．1±13．4)세。32개병례164빈심실불동부위기박12도련심전도,2명심전공작자쌍맹법수공측량RWPT,병비교불동부위심실기박RWPT차이。결과164빈기박심전도중152빈(92．7%)RWPT≥50 ms,12례(7．3%) RWPT<50 ms균위우좌심실유리벽、좌심실기저부기박조；우심실고위간격조(91．4±13．6)ms、우심실중위간격조(80．2±12．8)ms구유교고RWPT,좌심실심저부조(54．6±15．5)ms、좌심실유리벽조(51．3±9．5) ms, RWPT 교저( P<0．05)。결론심전도Ⅱ도련제1봉시한 RWPT≥50 ms시관QRS파심동과속판정위실성심률실상적간단、쾌첩、유효지표,특별대우우심실간격부、류입도기원실성심동과속(실속),이대우좌심실심저부、좌측유리벽기원실성심동과속감별민감성교차。
Objective This study was to clarify the characteristic of R-wave peak time ( RWPT ) in multi-chamber ventricular pacing model, to verify its value in differential diagnosis of wide QRS complex tachy-cardias. Methods Thirty-two patients with tachycardias underwent multi-chamber ventricular pacing after ra-diofrequency catheter ablation (RFCA) procedure, and 164 pacing electrocardiogram(ECG) were recorded. The RWPT ( DⅡ) were measured by two experienced electrophysiologist with double-blind method. Results The RWPT were≥50 ms in 152 ECG ( 92. 7%) , the RWPT were <50 ms in 12 ECG. The RWPT were ( 91. 4 ± 13. 6)ms when paced at high right ventricular septum, the RWPT were (80. 2±12. 8)ms when paced at middle right ventricular septum,the RWPT were (54. 6±15. 5)ms when paced at left ventricular freewall group (51. 3 ±9. 5)ms and (54. 6±15. 5)ms at left ventricular base part. Conclusion RWPT≥50 ms is a simple,fast,ef-fective criterion in distinguishing ventricular tachycardias from supraventricular tachycardia in patients with wide QRS complex tachycardia, especially origin from right ventricular septum,right ventricular inflow tract areas.