Lin Tao, Ma Yi-tong, Muhu Yati, Tang Bao-peng, Hou Yue-mei, Zhang Yan-yi
Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2011 Jan;39(1):69-72.
The aVR lead four steps is a new algorithm for differential diagnosis of wide QRS complex tachycardia (WCT). The study explores the clinical value of this new algorithm on differential diagnosis of WCT.
Application of aVR lead four steps to analysis the electrocardiogram of patients with WCT proved by electrophysiological study. Every step's accuracy rate, sensitivity and specificity to differential diagnosis of ventricular tachycardia (VT) were calculated. The first step diagnosed VT according to presence of an initial R wave in the aVR lead. The second step diagnosed VT according to width of an initial r or q wave > 40 ms in the aVR lead. The third step diagnosed VT according to notching on the initial downstroke of a predominantly negative QRS complex in the aVR lead. The fourth step diagnosis VT according to ventricular activation-velocity ratio (Vi/Vt) in the aVR lead, Vi/Vt ≤ 1 suggested VT. Results derived from aVR lead four steps algorithm were compared with results derived from Brugada and Vereckei four steps algorithm.
A total of 113 patients with WCT were analyzed (31 supraventricular tachycardia, SVT and 82 ventricular tachycardia, VT). The accuracy rate of differential diagnosis VT is 91.2%, sensitivity is 90.2% and specificity is 77.4%. The accuracy and sensitivity of the aVR lead four steps algorithm for differential diagnosis of WCT were superior to the Brugada Vereckei four steps algorithm (P < 0.05). The specificity of the Vereckei four steps algorithm was superior to aVR lead and Brugada four steps algorithm (P < 0.05), while the specificity of the aVR lead four steps algorithm was similar as Brugada four steps algorithm (P > 0.05).
The aVR lead four steps algorithm is associated with excellent accuracy rate, sensitivity for differential diagnosis of WCT. This algorithm is simple and could be easily learned and applied by physician.
aVR导联四步法是宽QRS波群心动过速（WCT）鉴别诊断的一种新算法。本研究探讨该新算法在WCT鉴别诊断中的临床价值。
应用aVR导联四步法分析经电生理检查证实为WCT患者的心电图。计算每一步对室性心动过速（VT）鉴别诊断的准确率、灵敏度和特异度。第一步根据aVR导联初始R波的有无诊断VT。第二步根据aVR导联初始r或q波宽度>40 ms诊断VT。第三步根据aVR导联以负向为主的QRS波群初始下降支的切迹诊断VT。第四步根据aVR导联的心室激动速度比（Vi/Vt）诊断VT，Vi/Vt≤1提示VT。将aVR导联四步法的结果与Brugada四步法和Vereckei四步法的结果进行比较。
共分析113例WCT患者（31例室上性心动过速，SVT和82例室性心动过速，VT）。VT鉴别诊断的准确率为91.2%，灵敏度为90.2%，特异度为77.4%。aVR导联四步法对WCT鉴别诊断的准确性和灵敏度优于Brugada - Vereckei四步法（P<0.05）。Vereckei四步法的特异度优于aVR导联四步法和Brugada四步法（P<0.05），而aVR导联四步法的特异度与Brugada四步法相似（P>0.05）。
aVR导联四步法对WCT鉴别诊断具有较高的准确率和灵敏度。该算法简单，医生易于学习和应用。
