Green M, Heddle B, Dassen W, Wehr M, Abdollah H, Brugada P, Wellens H J
Circulation. 1983 Aug;68(2):368-73. doi: 10.1161/01.cir.68.2.368.
To determine the value of alternation of QRS morphology in determining the site of origin of sustained narrow QRS supraventricular tachycardia (SVT), we retrospectively studied 163 distinct tachycardias in 161 patients (ages 4 to 91 years) in whom the site of origin of SVT was proven by intracardiac electrophysiologic study. Sustained SVT was defined as lasting longer than 30 sec. Narrow QRS was defined as QRS width less than 0.12 sec. Atrial fibrillation and flutter were excluded. The presence or absence of QRS alternation was judged at least 10 sec after initiation of SVT. Circus movement tachycardia with anterograde AV node conduction and a retrograde accessory AV pathway was seen in 89 patients (58 with Wolff-Parkinson-White syndrome, 31 with concealed accessory pathway); intra-AV nodal reentrant tachycardia (AVNT) was present in 57 cases, and 17 tachycardias were atrial in origin. QRS alternation was present in 36 of 163 cases (22%). In only eight of these 36 did RR interval length alternation accompany alternation in QRS morphology. Thirty-three of 36 (92%) tachycardias with QRS alternation were circus movement tachycardias. Two were atrial in origin and one was AVNT. We conclude that the presence of QRS alternation during sustained narrow QRS SVT is highly indicative of a retrograde accessory AV pathway in the tachycardia circuit.
为了确定QRS波形态改变在确定持续性窄QRS波室上性心动过速（SVT）起源部位中的价值，我们回顾性研究了161例患者（年龄4至91岁）的163次不同的心动过速，这些患者的SVT起源部位经心内电生理研究证实。持续性SVT定义为持续时间超过30秒。窄QRS波定义为QRS波宽度小于0.12秒。排除心房颤动和心房扑动。在SVT发作至少10秒后判断是否存在QRS波交替。89例患者出现伴有前向房室结传导和逆向房室旁路的折返性心动过速（58例为预激综合征，31例为隐匿性旁路）；57例存在房室结内折返性心动过速（AVNT），17次心动过速起源于心房。163例中有36例（22%）出现QRS波交替。在这36例中，只有8例RR间期长度交替伴随QRS波形态改变。36例出现QRS波交替的心动过速中，33例（92%）为折返性心动过速。2例起源于心房，1例为AVNT。我们得出结论，持续性窄QRS波SVT期间出现QRS波交替高度提示心动过速环路中存在逆向房室旁路。
