Ohlow M-A, Beierlein A, Müller S, von Korn H, Geller J-C, Yu J, Lauer B
Klinik für Kardiologie, Herzzentrum, Zentralklinik Bad Berka.
Dtsch Med Wochenschr. 2005 Nov 25;130(47):2694-8. doi: 10.1055/s-2005-922056.
Sustained, stable wide QRS-complex tachycardia (WCT) remains a diagnostic challenge, because the treatment of supra-ventricular tachycardia (SVT) with aberrant conduction differs considerably from that of a ventricular tachycardia (VT). A usual recommendation for treating a case of a stable WCT is to manage it as if it were VT, in accordance with the consideration of "first do no harm". The aim of this study was to determine whether Board-certified emergency-physicians are able to differentiate VT from SVT with aberrant conduction in a high percentage of cases (> 90%), thus to assure more precise prehospital treatment."
Eight electrocardiograms with WCT (four with electrophysiologically proven VT or SVT, respectively) were evaluated in a blinded fashion by 64 Board-certified emergency-physicians (23 female, 41 male, mean age: 37,8 + 5,1 years). Initially, the diagnosis had to be made without any further information. Afterwards the same electrocardiograms were presented again, providing important additional information.
55% of the study population were able to establish the correct diagnosis merely by evaluating the electrocardiogram. Providing the above mentioned additional information, the number of correct diagnoses increased to 61%. These results were roughly similar in all subgroups, only the subgroup of cardiologists showed a trend to better results with correct diagnoses in 68% without and 73 % with additional information. None of the subgroups reached the pre-specified cut-off of > or = 90% correct diagnoses. Specialist status as well as experience in emergency medicine had no significant influence on the results, only the subgroup of emergency physicians with an experience of more than five years showed a trend towards a higher rate of correct diagnosis, compared with the subgroup with less than one year experience in emergency medicine.
In cases of stable WCT the evaluation of the electrocardiogram without further information in prehospital emergency-medicine leads to unsatisfactory results. The correct diagnosis in WCT can be improved by using additional data but the diagnostic accuracy is still low. Therefore, the differential diagnosis of stable WCT in preclinical emergency-medicine cannot be recommended. Until proven otherwise, any stable WCT should be managed as if it were VT.
持续性、稳定的宽QRS波群心动过速（WCT）仍然是一个诊断难题，因为伴有差异性传导的室上性心动过速（SVT）的治疗与室性心动过速（VT）的治疗有很大不同。根据“首先不造成伤害”的考量，对于稳定型WCT病例的常规治疗建议是将其当作VT来处理。本研究的目的是确定获得委员会认证的急诊医生能否在高比例（>90%）的病例中区分VT和伴有差异性传导的SVT，从而确保更精确的院前治疗。
64名获得委员会认证的急诊医生（23名女性，41名男性，平均年龄：37.8±5.1岁）以盲法评估了八份WCT心电图（其中四份分别经电生理证实为VT或SVT）。最初，必须在没有任何进一步信息的情况下做出诊断。之后再次展示相同的心电图，并提供重要的附加信息。
55%的研究对象仅通过评估心电图就能做出正确诊断。提供上述附加信息后，正确诊断的数量增加到61%。所有亚组的结果大致相似，只有心脏病专家亚组显示出更好结果的趋势，无附加信息时正确诊断率为68%，有附加信息时为73%。没有一个亚组达到预先设定的>或=90%正确诊断的临界值。专业地位以及急诊医学经验对结果没有显著影响，只有急诊经验超过五年的医生亚组与急诊经验少于一年的医生亚组相比，显示出正确诊断率更高的趋势。
在院前急诊医学中，对于稳定型WCT病例，在没有进一步信息的情况下评估心电图会导致不尽人意的结果。使用附加数据可以提高WCT的正确诊断率，但诊断准确性仍然较低。因此，不建议在临床前急诊医学中对稳定型WCT进行鉴别诊断。在未得到其他证实之前，任何稳定型WCT都应当作VT来处理。
