Tomcsányi J, Somlói M, Tenczer J, Karlócai K
Országos Korányi Tbc és Pulmonológiai Intézet, Budapest.
Orv Hetil. 1998 Nov 15;139(46):2779-81.
To distinguish supraventricular tachycardia with aberrancy from ventricular tachycardia is sometimes difficult. It seems to be easy to distinguish the two forms in patients with preexisting bundle branch block: if the QRS morphology during tachycardia is identical to those during at rest the tachycardia is supraventricular, if different, ventricular. We present two cases with preexisting bundle branch block and wide complex tachycardia whose QRS morphologies were almost same to those during normal rest rhythm. The atrioventricular dissociation and the response to adenosine and lidocaine strongly suggests ventricular tachycardia. In these cases ventricular tachycardia masqueraded as supraventricular tachycardia and the identical QRS morphology with the preexisting bundle branch block may suggest a misdiagnosis of supraventricular tachycardia.
有时很难区分伴有差异性传导的室上性心动过速与室性心动过速。对于已有束支传导阻滞的患者,区分这两种形式似乎很容易:如果心动过速时的QRS形态与静息时相同,则心动过速为室上性;如果不同,则为室性。我们报告两例已有束支传导阻滞且伴有宽QRS波心动过速的病例,其QRS形态与正常静息节律时几乎相同。房室分离以及对腺苷和利多卡因的反应强烈提示为室性心动过速。在这些病例中,室性心动过速伪装成室上性心动过速,且与已有的束支传导阻滞具有相同的QRS形态可能提示室上性心动过速的误诊。