Wren C, Campbell R W, Hunter S
Br Heart J. 1985 Aug;54(2):166-72. doi: 10.1136/hrt.54.2.166.
It is not always easy to distinguish between supraventricular tachycardia with aberration and ventricular tachycardia by electrocardiographic analysis alone. M mode echocardiography can often help by providing direct or indirect evidence of the relation between atrial and ventricular contraction. Sixteen consecutive patients with spontaneous sustained broad QRS complex tachycardia with heart rates of 120-225 beats/minute were examined. Echocardiographic evidence of 1:1 conduction was seen in three cases and 2:1 atrioventricular conduction in one (all four had supraventricular tachycardia, confirmed by intracardiac electrocardiography in three). Evidence of retrograde block was seen in 12 (all had ventricular tachycardia, with electrophysiological confirmation in 10). Satisfactory views of the mitral valve were obtained in all patients. Patients with ventricular tachycardia had a variable mitral valve opening time (range 42-110%) compared with those who had supraventricular tachycardia (9-15%). Aortic root and left atrial views gave direct evidence of atrial contraction in three cases, and subcostal right atrial wall views were diagnostic in four of five cases. Seven patients with ventricular tachycardia had been wrongly diagnosed elsewhere as having supraventricular tachycardia. This study confirms that echocardiography is a simple and rapid aid to accurate diagnosis in patients with broad QRS complex tachycardia.
仅通过心电图分析来区分伴有差异性传导的室上性心动过速和室性心动过速并非总是容易的。M型超声心动图通常可以通过提供心房和心室收缩关系的直接或间接证据来提供帮助。对连续16例心率为120 - 225次/分钟的自发性持续性宽QRS波群心动过速患者进行了检查。在3例患者中发现了1:1传导的超声心动图证据，1例为2:1房室传导（这4例均为室上性心动过速，3例经心内心电图证实）。在12例患者中发现了逆行阻滞的证据（均为室性心动过速，10例经电生理证实）。所有患者均获得了满意的二尖瓣图像。与室上性心动过速患者（9% - 15%）相比，室性心动过速患者的二尖瓣开放时间各不相同（范围为42% - 110%）。主动脉根部和左心房图像在3例患者中提供了心房收缩的直接证据，肋下右心房壁图像在5例中的4例中具有诊断价值。7例室性心动过速患者在其他地方被误诊为室上性心动过速。这项研究证实，超声心动图是帮助准确诊断宽QRS波群心动过速患者的一种简单而快速的方法。
