左前分支阻滞中前Q波的意义——一项临床及无创评估

Significance of anterior Q waves in left anterior fascicular block--a clinical and noninvasive assessment.

作者信息

Shettigar Udipi R, Pannuri Anu, Barbier George H, Appunn Doreen O

机构信息

Cardiology Section, Bay Pines VA Medical Center, Florida 33744, USA.

出版信息

Clin Cardiol. 2002 Jan;25(1):19-22. doi: 10.1002/clc.4950250106.

DOI:10.1002/clc.4950250106

PMID:11808834

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654265/

Abstract

BACKGROUND

Electrocardiographic (ECG) Q waves in V leads (V2 or V3) pose a diagnostic challenge in the presence of left anterior fascicular block (LAFB). Benign Q waves in the absence of coronary artery disease (CAD) primarily due to LAFB have been described. This study evaluates Q waves in the presence of LAFB.

HYPOTHESIS

Anterior Q waves in the presence of LAFB may not be indicative of myocardial infarction (MI).

METHODS

From 1990 to 1997, ECGs of 236 male patients with LAFB were analyzes for presence of Q waves in the V leads. Records were reviewed for evidence of CAD. Of 236 patients with LAFB, 61 (26%) had Q waves in the V leads. In this group, 31 patients were available for further analysis.

RESULTS

Of the 31 patients with Q waves in the V leads who were available for further study, LAFB was present in 22 patients (71%) and LAFB plus right bundle-branch block (RBBB) were present in 9 (29%). Of 20 patients with Q waves due to MI, 13 (65%) had LAFB and 7 (35%) had LAFB plus RBBB. Of 11 patients with benign Q waves, 9 (82%) and 2 (18%) had LAFB and LAFB plus RBBB, respectively. Benign Q waves were noted in 5.3% (11/206) patients with LAFB. The mean duration of Q waves and Q-wave location limited to V2 and/or V3 are 0.029 s and 64% versus 0.053 s and 15% in benign versus pathologic Q waves, respectively.

CONCLUSION

Patients with LAFB in the absence of MI may have Q waves in the V leads that are approximately 0.02 s in duration and restricted to one or two leads. This anomaly may represent a variation of conduction in the initial 0.02 s QRS vector due to LAFB.

摘要

背景

在存在左前分支阻滞（LAFB）的情况下，V导联（V2或V3）的心电图（ECG）Q波带来了诊断挑战。已经描述了在无冠状动脉疾病（CAD）时主要由LAFB导致的良性Q波。本研究评估存在LAFB时的Q波情况。

假设

存在LAFB时的前壁Q波可能并非心肌梗死（MI）的指征。

方法

1990年至1997年，分析了236例患有LAFB的男性患者的心电图以确定V导联中Q波的存在情况。审查记录以寻找CAD的证据。在236例LAFB患者中，61例（26%）V导联有Q波。在该组中，31例患者可供进一步分析。

结果

在可供进一步研究的31例V导联有Q波的患者中，22例（71%）存在LAFB，9例（29%）存在LAFB加右束支传导阻滞（RBBB）。在20例因MI出现Q波的患者中，13例（65%）有LAFB，7例（35%）有LAFB加RBBB。在11例有良性Q波的患者中，分别有9例（82%）和2例（18%）有LAFB和LAFB加RBBB。在LAFB患者中，5.3%（11/206）出现良性Q波。良性Q波和病理性Q波的Q波平均时限分别为0.029秒和0.053秒，局限于V2和/或V3的Q波位置分别为64%和15%。