Curione M, Fuoco U, Borgia C, Putini R L, Puletti M
Department of Internal Medicine, University of Rome La Sapienza, Italy.
Clin Cardiol. 1988 Apr;11(4):250-2. doi: 10.1002/clc.4960110410.
A study was carried out on 12 patients with wide QRS tachycardia, 8 of whom presented with atrioventricular (AV) dissociation (Group A) and 4 with 1:1 AV association (Group B). This investigation aimed at assessing whether significant variations occurred in the QRS amplitude between the two groups. Group A showed more marked variations in QRS amplitude (31.7 +/- 13%) compared to Group B patients (6.2 +/- 1.2%) (p less than 0.001). The amplitude changes observed in Group A patients are probably related to variations in telediastolic volume resulting from the occasional contribution of the atrial systole. The findings suggest that variability in QRS amplitude during wide QRS tachyarrhythmias is a reliable sign of the presence of an AV dissociation. The possibility of diagnosing an AV dissociation on a surface ECG without visible P waves is an important finding, which though not pathognomonic of ventricular tachycardia, is a valid ECG criterion for assessing the ventricular origin of arrhythmias. This ECG criterion can be usefully applied in clinical practice along with others already used for the differential diagnosis of wide QRS tachyarrhythmias.
对12例宽QRS心动过速患者进行了一项研究，其中8例出现房室分离（A组），4例出现1:1房室关系（B组）。本研究旨在评估两组之间QRS波振幅是否存在显著差异。与B组患者（6.2±1.2%）相比，A组的QRS波振幅变化更为明显（31.7±13%）（p<0.001）。A组患者观察到的振幅变化可能与心房收缩偶尔导致的舒张末期容积变化有关。研究结果表明，宽QRS心动过速期间QRS波振幅的变化是房室分离存在的可靠标志。在体表心电图上无可见P波时诊断房室分离的可能性是一项重要发现，虽然这不是室性心动过速的特征性表现，但却是评估心律失常心室起源的有效心电图标准。该心电图标准可与已用于宽QRS心动过速鉴别诊断的其他标准一起有效地应用于临床实践。
