Bayar Nermin, Arslan Şakir, Köklü Erkan, Cagirci Göksel, Cay Serkan, Erkal Zehra, Ayoglu Raif Umut, Küçükseymen Selçuk
Antalya Education and Research Hospital, Antalya, Turkey.
Kardiol Pol. 2015;73(5):331-6. doi: 10.5603/KP.a2014.0240. Epub 2015 Jan 7.
Atrial septal defect (ASD) is the most frequent heart defect observed in adulthood. Although it is usually non-symptomatic, it may result in heart failure, arrhythmic complications, and paradoxical embolism-related morbidity or mortality if the diagnosis is late.
This study was planned in order to investigate the importance of electrocardiographic findings in the diagnosis of ASD.
Sixty-one patients with a diagnosis of ASD and 66 healthy volunteers without cardiac disease were enrolled in the study. Electrocardiographs (ECG) were performed on all patients to investigate the presence of right bundle branch block (RBBB), incomplete RBBB, defective T wave (DTW), and notch finding in the R wave of inferior derivations (crochetage R wave). ASD types and diameters were determined via transthoracic and transoesophageal echocardiography.
It was determined that incomplete RBBB (56% vs. 5%), DTW (48% vs. 3%), and R wave crochetage (57% vs. 8%) in inferior derivations were more frequent in ASD patients compared to the control group patients. The specificity of the defined ECG findings in the diagnosis of ASD were 95%, 97%, and 92%, respectively. No correlation was detected between the ASD diameter and incomplete RBBB, whereas significant correlation was observed between the ASD diameter and the presence of crochetage R wave (17.5 ± 4.0 mm in patients with crochetage R wave, and 20.9 ± 8.2 mm in patients without crochetage R wave, p = 0.057).
Detection of RBBB, DTW, and crochetage R wave in superficial ECG may contribute to early detection in patients with ASD.
房间隔缺损（ASD）是成人中最常见的心脏缺陷。虽然它通常无症状，但如果诊断延迟，可能会导致心力衰竭、心律失常并发症以及与反常栓塞相关的发病或死亡。
本研究旨在探讨心电图表现对ASD诊断的重要性。
本研究纳入了61例诊断为ASD的患者和66例无心脏病的健康志愿者。对所有患者进行心电图检查，以调查是否存在右束支传导阻滞（RBBB）、不完全性RBBB、T波异常（DTW）以及下壁导联R波切迹（R波钩）。通过经胸和经食管超声心动图确定ASD类型和直径。
与对照组患者相比，并确定下壁导联不完全性RBBB（56%对5%）、DTW（48%对3%）和R波钩（57%对8%）在ASD患者中更常见。所定义的心电图表现对ASD诊断的特异性分别为95%、97%和92%。未检测到ASD直径与不完全性RBBB之间的相关性，而观察到ASD直径与R波钩的存在之间存在显著相关性（有R波钩的患者为17.5±4.0mm，无R波钩的患者为20.9±8.2mm，p=0.057）。
体表心电图中检测到RBBB、DTW和R波钩可能有助于ASD患者的早期发现。
