Farré Jerónimo, Rubio José-Manuel, Sternick Eduardo Back
Madrid Autonomous University, Spain.
Director of the Arrhythmia Unit, Fundación Jiménez Díaz University Hospital and Institute of Health Sciences Research, Madrid, Spain.
Indian Pacing Electrophysiol J. 2023 Jan-Feb;23(1):1-13. doi: 10.1016/j.ipej.2022.11.002. Epub 2022 Dec 5.
Studies conducted during the last 50 years have proposed electrocardiographic criteria and algorithms to determine if a wide QRS tachycardia is ventricular or supraventricular in origin. Sustained ventricular tachycardia is an uncommon reason for consultation in the emergency room. The latter and the complexity of available electrocardiographic diagnostic criteria and algorithms result in frequent misdiagnoses. Good hemodynamic tolerance of tachycardia in the supine position does not exclude its ventricular origin. Although rare, ventricular tachycardia in patients with and without structural heart disease may show a QRS duration <120 ms. Interruption of tachycardia by coughing, carotid sinus massage, Valsalva maneuver, or following the infusion of adenosine or verapamil should not discard the ventricular origin of the arrhythmia. In patients with regular, uniform, sustained broad QRS tachycardia, the presence of structural heart disease or A-V dissociation strongly suggest its ventricular origin. Occasionally, ventricular tachycardia can present with AV dissociation without this being evident on the 12-lead ECG. Cardiac auscultation, examination of the jugular venous pulse, and arterial pulse palpation provide additional clues for identifying A-V dissociation during tachycardia. This paper does not review the electrocardiographic criteria for categorizing tachycardia as ventricular but rather why emergency physicians misdiagnose these patients.
过去50年进行的研究提出了心电图标准和算法，以确定宽QRS波心动过速的起源是室性还是室上性。持续性室性心动过速是急诊室会诊的不常见原因。后者以及现有心电图诊断标准和算法的复杂性导致频繁误诊。心动过速在仰卧位时良好的血流动力学耐受性并不能排除其室性起源。虽然罕见，但有或无结构性心脏病患者的室性心动过速可能表现为QRS波时限<120毫秒。咳嗽、颈动脉窦按摩、瓦尔萨尔瓦动作或静脉注射腺苷或维拉帕米后心动过速中断，不应排除心律失常的室性起源。在规则、形态一致、持续性宽QRS波心动过速的患者中，存在结构性心脏病或房室分离强烈提示其室性起源。偶尔，室性心动过速可伴有房室分离，但在12导联心电图上并不明显。心脏听诊、颈静脉搏动检查和动脉搏动触诊为心动过速期间识别房室分离提供了额外线索。本文不回顾将心动过速分类为室性的心电图标准，而是探讨急诊医生为何会误诊这些患者。
