Griffith M J, de Belder M A, Linker N J, Ward D E, Camm A J
Department of Cardiological Sciences, St George's Hospital Medical School, London, U.K.
Eur Heart J. 1992 Apr;13(4):478-83. doi: 10.1093/oxfordjournals.eurheartj.a060200.
In patients with left bundle branch block pattern tachycardia, electrocardiographic criteria, based on leads V1, V2 and V6, have been shown to be effective for the diagnosis of ventricular tachycardia in patients with a previous myocardial infarct. To test these criteria on a wider population, we studied 53 consecutive patients with left bundle branch block pattern tachycardia. Seventeen patients had supraventricular tachycardia and 36 had ventricular tachycardia, 18 with a previous myocardial infarction, two with cardiomyopathy, and 16 with a normal heart. The sensitivity for the diagnosis of ventricular tachycardia in patients with a previous myocardial infarct of the combined criteria was 100% but was only 50% for the other patients, which was not significantly different from the patients with supraventricular tachycardia (29%). Two other criteria, right axis shift in tachycardia and ventricular ectopics during sinus rhythm with the same morphology as the tachycardia, were only seen in patients with ventricular tachycardia, and combined with the other criteria allowed the correct identification of 35/36 patients with ventricular tachycardia. To conclude, the electrocardiographic criteria based on leads V1, V2 and V6 are not sensitive for the diagnosis of a ventricular origin of left bundle branch block pattern tachycardia in patients with a normal heart and additional criteria are required for the diagnosis in these patients.
在左束支传导阻滞型心动过速患者中，基于V1、V2和V6导联的心电图标准已被证明对诊断既往有心肌梗死的患者的室性心动过速有效。为了在更广泛的人群中检验这些标准，我们研究了53例连续的左束支传导阻滞型心动过速患者。17例为室上性心动过速，36例为室性心动过速，其中18例既往有心肌梗死，2例有心肌病，16例心脏正常。联合标准对既往有心肌梗死患者诊断室性心动过速的敏感性为100%，但对其他患者仅为50%，与室上性心动过速患者（29%）无显著差异。另外两个标准，即心动过速时电轴右偏和窦性心律时形态与心动过速相同的室性期前收缩，仅见于室性心动过速患者，与其他标准联合可正确识别35/36例室性心动过速患者。总之，基于V1、V2和V6导联的心电图标准对诊断心脏正常的左束支传导阻滞型心动过速的室性起源不敏感，这些患者的诊断需要额外的标准。
