Gussak I, Wright R S, Bjerregaard P, Chaitman B R, Zhou S H, Hammill S C, Kopecky S L
Mayo Physician Alliance for Clinical Trials, Mayo Clinic (Stabile 5), 150 Third Street SW, Rochester, MN 55902, USA.
Cardiology. 2000;94(3):165-72. doi: 10.1159/000047312.
Right bundle-branch block (RBBB) has not traditionally been seen as an obstacle to ECG diagnosis of Q wave myocardial infarction (MI)--in clinical electrocardiography and vectorcardiography--because this conduction disturbance is not believed to cause significant alterations in the spatial orientation of initial excitation wavefronts. In the era of large-scale clinical trials, however, where serial ECG analysis is among the major diagnostic tools in MI classification, both false-positive and false-negative diagnoses of MI in the presence of RBBB have become increasingly evident. Because of the limited detectability of Q wave MI by ECG in the presence of RBBB, the electrocardiographic finding of Q wave MI should not be regarded as an independent diagnostic tool. It is best to utilize independent corroboration to establish the diagnosis of transmural infarction when RBBB is present. Further investigations are warranted to better delineate sensitivity, specificity, and predictive value of Q wave MI in the presence of RBBB.
传统上，右束支传导阻滞（RBBB）在临床心电图和向量心电图中并未被视为阻碍Q波心肌梗死（MI）心电图诊断的因素，因为这种传导障碍被认为不会导致初始兴奋波前的空间方向发生显著改变。然而，在大规模临床试验时代，连续心电图分析是MI分类的主要诊断工具之一，RBBB存在时MI的假阳性和假阴性诊断变得越来越明显。由于在RBBB存在的情况下，心电图对Q波MI的检测能力有限，Q波MI的心电图表现不应被视为独立的诊断工具。当存在RBBB时，最好利用独立的证据来确立透壁性梗死的诊断。有必要进行进一步的研究，以更好地描述RBBB存在时Q波MI的敏感性、特异性和预测价值。
