Stewart R B, Bardy G H, Greene H L
Ann Intern Med. 1986 Jun;104(6):766-71. doi: 10.7326/0003-4819-104-6-766.
The extent and consequence of misdiagnosis of wide complex tachycardia (QRS, 120 ms or more; heart rate, 100 or more beats/min) presenting emergently were assessed. Forty-six consecutive episodes of wide complex tachycardia were reviewed and their tachycardia mechanisms subsequently established. All 8 episodes of supraventricular tachycardia with aberrant conduction were correctly diagnosed, whereas 15 of 38 episodes of ventricular tachycardia (39%) were misdiagnosed as supraventricular tachycardia at the time initial therapy was given. Ventriculoatrial dissociation was evident in 11 (73%) of the electrocardiograms of misdiagnosed ventricular tachycardia. Patients with misdiagnosed episodes had poorer outcomes than those with episodes correctly diagnosed (p = 0.0003). Verapamil was administered to patients in 13 of the 15 episodes of misdiagnosed ventricular tachycardia; hemodynamic deterioration occurred in all 13 episodes. Wide complex tachycardia is often incorrectly diagnosed as supraventricular tachycardia when, in fact, the 12-lead electrocardiogram strongly suggests ventricular tachycardia. Verapamil is commonly administered in these circumstances and is frequently associated with a poor outcome.
对紧急情况下出现的宽QRS波心动过速（QRS时限≥120毫秒，心率≥100次/分钟）的误诊程度及后果进行了评估。回顾了46例连续的宽QRS波心动过速发作病例，并随后确定了其心动过速机制。所有8例伴有差异性传导的室上性心动过速均被正确诊断，而在38例室性心动过速发作中，有15例（39%）在开始初始治疗时被误诊为室上性心动过速。在误诊为室性心动过速的心电图中，11例（73%）可见室房分离。误诊发作的患者比正确诊断发作的患者预后更差（p = 0.0003）。在15例误诊为室性心动过速的发作中，有13例患者使用了维拉帕米；所有13例均出现血流动力学恶化。当12导联心电图强烈提示室性心动过速时，宽QRS波心动过速常被错误地诊断为室上性心动过速。在这种情况下，维拉帕米常被使用，且常与不良后果相关。
