宽QRS波心动过速鉴别诊断

宽QRS波心动过速鉴别诊断

DifferentialdiagnosisofwideQRScomplextachycardia（WCT）ECGdiagnosisofWCTManyreliablecriteriatoruleinVTNoreliablecriteriatoruleoutVTWhenindoubt,assumeandtreatWCTasVT…ECGdiagnosisofWCTBrugadacriteria(Circulation,1991)1AbsenceofRScomplexinallprecordialleads2RSinterval>100ms,inoneprecordiallead3AVdissociation4MorphologycriteriaforVTpresentinprecordialeadsV1-2andV6Sensitivity98.7%,specificity96.5%房室分离AVdissociation

房室分离AVdissociation

房室分离AVdissociation融合波Fusionbeats融合波Fusionbeats夺获Capture夺获CaptureMorphology

inV1&V6

ECGDiagnosisofWCTHerbert,etal(AnnEmergMed,1996)--27ECGswithWCTfromEDrecords--Threeemergencyphysicians--ApplyBrugadacriteria--6/27(22%)disagreementindistinguishingVTfromSVT-ACECGdiagnosisofWCTIsenhour,etal(AcadEmergMed,2000)--157ECGswithWCT，finaldiagnosisconfirmedbyEPS--Twocardiologists，twoemergencyphysicians--ApplyBrugadacriteria--EmergPhysicians：83%and79%sensitivity --Cardiologists:85%and91%sensitivityECGdiagnosisofWCTBestattemptstocreatealgorithmtodistinguishVTvs.SVT-AC--Brugadacriteria(Circulation1991)--Vereckeialgorithm(EurHeartJ2007)--Vereckei`saVRalgorithm(HeartRhythm2008)ECGdiagnosisofWCTSasaki(AHAPresentation2009)comparedsensitivitisfro71VTcases--Brugadacriteria86%--Vereckeialgorithm76%--Vereckei`saVRalgorithm86%--Vereckeialgorithm76%--Vereckei`saVRalgorithm86%--Brugadacriteria86%SensitivityforVTECGdiagnosisofWCTJastrzebskiM,etal.Eurpace2012260WCTsofwhich159wereVTsSensitivitiesfordetectingVT…--ComparedaccuraciesatdxofWCTofBrugadaalgorithm89%Bayesionalgorithm89%Grittithalgorithm94%(worstspecificity40%)VereckeiaVRalgorithm87%LeadIIR-wave-peak-timealgorithm60%ECGdiagnosisofWCTManyreliablecriteriatoruleinVTNoreliablecriteriatoruleoutVT--NoreliablecriteriatoruleinSVT-AC,except…VTorSVTwithRBBBBaselinewithRBBB84yomanwithpalpitationAfteradenosine54yomanwithpalpitationsandstableBP；noCADAfteradenosineACLS2010IVadenosineisrelativelysafeforbothtreatmentanddiagnosis(ClassIIb,LOEB)Adenosineonlyconverted2/81VTbut48%ofpatientsdiagnosedwithSVTwerediagnosedbecausetheyconvertedwithadenosineAdenosineisprobablysafebut

responsetoadenosineDOESNOTruleoutVTSVT—HomeVT—CCU,EPstudy,possibleICDA-fibwithWPWAfteramidaroneA-fibwithWPWAfter200JshockAmidaronevsCardioversioninA-fibwithWPWAfterprocainamideDDxforwideQRSVentrucularectopyPacedbeatsBBBWPWNon-specificIVCD,egLVH,CMPYMedicationtoxicityMetabolic,eghyperK,acidosisReallywideQRSTreatmentforWCTShockVentricularantiarrhythmicsCalciumSodiumbicarbonateAfterbicarbIsittoolowforVT?IsittoowideforVT?AfterbicarbandCa2+K+8.8mmol/LHyperkalemiaPeak