简单的心电图标准用于快速识别宽 QRS 心动过速：新的肢体导联算法。
Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia: The new limb lead algorithm.
机构信息
Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Heart Rhythm. 2020 Mar;17(3):431-438. doi: 10.1016/j.hrthm.2019.09.021. Epub 2019 Sep 20.
BACKGROUND
The electrocardiogram (ECG) is essential for the differential diagnosis of wide QRS complex tachycardia (WCT).
OBJECTIVE
The purpose of this study was to evaluate the diagnostic value of a novel ECG algorithm on the basis of the morphological characteristics of the QRS on the limb leads.
METHODS
The limb lead algorithm (LLA) was evaluated by analyzing 528 monomorphic WCTs with electrophysiology-confirmed diagnoses. In the LLA, ventricular tachycardia (VT) is diagnosed in the presence of at least 1 of the following: (1) monophasic R wave in lead aVR; (2) predominantly negative QRS in leads I, II, and III; and (3) opposing QRS complex in the limb leads: concordant monophasic QRS in all 3 inferior leads and concordant monophasic QRS in 2 or 3 of the remaining limb leads with a polarity opposite to that of the inferior leads. The diagnostic performance of the LLA was compared with that of the Brugada, Vereckei, and R-wave peak time (RWPT) algorithms.
RESULTS
Of 528 WCT cases, 397 were VT and 131 supraventricular tachycardia. The interobserver agreement for the LLA was excellent (κ = 0.98), better than that for the other algorithms. The overall accuracy of the LLA (88.1%) was similar to that of Brugada (85.4%) and Vereckei (88.1%) algorithms but was higher than that of the RWPT algorithm (70.8%). The LLA had a lower sensitivity (87.2%) than did Brugada (94.0%) and Vereckei (92.4%) algorithms, but not the RWPT algorithm (67.8%). Furthermore, the LLA showed a higher specificity (90.8%) than did Brugada (59.5%), Vereckei (76.3%), and RWPT (80.2%) algorithms.
CONCLUSION
The LLA is a simple yet accurate method to diagnose VT when approaching WCTs on the ECG.
背景
心电图（ECG）对于宽 QRS 复合心动过速（WCT）的鉴别诊断至关重要。
目的
本研究旨在基于肢体导联 QRS 波形态特征，评估一种新的心电图算法的诊断价值。
方法
通过分析 528 例经电生理证实的单形性 WCT，评估肢体导联算法（LLA）。在 LLA 中，当存在以下至少 1 种情况时，诊断为室性心动过速（VT）：（1）aVR 导联呈单相 R 波；（2）I、II、III 导联 QRS 波主要呈负向；（3）肢体导联呈相反 QRS 波群：所有 3 个下导呈一致单相 QRS 波，其余 2 或 3 个肢体导呈与下导相反极性的一致单相 QRS 波。LLA 的诊断性能与 Brugada、Vereckei 和 R 波峰时间（RWPT）算法进行比较。
结果
528 例 WCT 中，397 例为 VT，131 例为室上性心动过速。LLA 的观察者间一致性极好（κ=0.98），优于其他算法。LLA 的总体准确率（88.1%）与 Brugada（85.4%）和 Vereckei（88.1%）算法相似，但高于 RWPT 算法（70.8%）。LLA 的敏感性（87.2%）低于 Brugada（94.0%）和 Vereckei（92.4%）算法，但与 RWPT 算法（67.8%）无差异。此外，LLA 的特异性（90.8%）高于 Brugada（59.5%）、Vereckei（76.3%）和 RWPT（80.2%）算法。
结论
在心电图上处理 WCT 时，LLA 是一种简单而准确的诊断 VT 的方法。
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