vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2019-3-48-56vestar-169Research ArticleОБЗОРЫREVIEWSДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ТАХИКАРДИЙ С ШИРОКИМИ КОМПЛЕКСАМИ QRS: ОТ «КЛАССИЧЕСКИХ» ПРИЗНАКОВ К ПЕРВЫМ АЛГОРИТМАМDIFFERENTIAL DIAGNOSIS OF TACHYCARDIA WITH WIDE QRS COMPLEXES: FROM «CLASSICAL» SIGNS TO THE FIRST ALGORITHMSМедведевМ. М.MedvedevM. M.

Медведев Михаил Маркович

Mikhail M. Medvedev

mikhmed@mail.ruНаучно-клинический и образовательный центр «Кардиология» Санкт-Петербургского государственного университетаРоссияScientific-Clinical and Educational Center «Cardiology» of St. Petersburg State UniversityRussian Federation2019180220202634856Copyright © Медведев М.М., 20202020Медведев М.М.Medvedev M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/169

Рассматриваются причины появления и клиническое значение «широких» комплексов QRS, анализируются результаты первых исследований, направленных на определение критериев и выработку алгоритмов дифференциальной диагностики тахикардий, протекающих с «широкими» комплексами QRS.

The causes and clinical significance of the “wide” QRS complexes are considered, the results of the first studies aimed at determining the criteria and the development of algorithms for differential diagnosis of tachycardia occurring with the “wide” QRS complexes are analyzed.

дифференциальная диагностикажелудочковая тахикардиясуправентрикулярная тахикардияблокады ножек пучка Гисааберрантное проведениедополнительные пути проведенияэлектрокардиография«широкие» комплексы QRSReferencesStewart RB, Bardy GH, Greene HL. Wide complex tachycardia - misdiagnosis and outcome after emergent therapy. Ann Intern Med 1986; 104: 766-71.Stewart RB, Bardy GH, Greene HL. Wide complex tachycardia - misdiagnosis and outcome after emergent therapy. Ann Intern Med 1986; 104: 766-71.Buxton AE, Marchlinski FE, Doherty JU et al. Hazards of intravenous verapamil for sustained ventricular tachycardia. Am J Cardiol 1987; 59: 1107-10.Buxton AE, Marchlinski FE, Doherty JU et al. Hazards of intravenous verapamil for sustained ventricular tachycardia. Am J Cardiol 1987; 59: 1107-10.Варшавский С.Ю., Медведев М.М. Купирование приступов суправентрикулярных тахикардий на догоспитальном этапе: финоптин или аденозинтрифосфат? Кардиология. 1990. Т. 30. № 11. С. 22 [Varshavsky S.Yu., Medvedev M.M. Relief of attacks of supraventricular tachycardia at the prehospital stage: fi noptin or adenosine triphosphate? Cardiology. 1990.V. 30. No. 11. P. 22 (in Russ.)].Варшавский С.Ю., Медведев М.М. Купирование приступов суправентрикулярных тахикардий на догоспитальном этапе: финоптин или аденозинтрифосфат? Кардиология. 1990. Т. 30. № 11. С. 22 [Varshavsky S.Yu., Medvedev M.M. Relief of attacks of supraventricular tachycardia at the prehospital stage: fi noptin or adenosine triphosphate? Cardiology. 1990.V. 30. No. 11. P. 22 (in Russ.)].Priori S.G., Blomstrom-Lundqvist C., Mazzanti A. et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015 Nov 1; 36(41): 2793-867.Priori S.G., Blomstrom-Lundqvist C., Mazzanti A. et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015 Nov 1; 36(41): 2793-867.Al-Khatib S.M., Stevenson W.G., Ackerman M.J. et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary Heart Rhythm, Volume 15, Issue 10, e190 - e252.Al-Khatib S.M., Stevenson W.G., Ackerman M.J. et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary Heart Rhythm, Volume 15, Issue 10, e190 - e252.Ревишвили А.Ш., Неминущий Н.М., Баталов Р.Е. и др. Всероссийские клинические рекомендации по контролю над риском внезапной остановки сердца и внезапной сердечной смерти, профилактике и оказанию первой помощи // Вестник аритмологии, 2017, № 89, с. 1-104 .Ревишвили А.Ш., Неминущий Н.М., Баталов Р.Е. и др. Всероссийские клинические рекомендации по контролю над риском внезапной остановки сердца и внезапной сердечной смерти, профилактике и оказанию первой помощи // Вестник аритмологии, 2017, № 89, с. 1-104 .Page RL, Joglar JA, Caldwell MA et al. 2015 ACC/ AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13; e136-e221.Page RL, Joglar JA, Caldwell MA et al. 2015 ACC/ AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13; e136-e221.Katritsis D.G., Boriani G., Cosio F.G. et al. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias. EP Europace, Volume 19, Issue 3, March 2017, Pages 465- 511, https://doi.org/10.1093/europace/euw301.Katritsis D.G., Boriani G., Cosio F.G. et al. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias. EP Europace, Volume 19, Issue 3, March 2017, Pages 465- 511, https://doi.org/10.1093/europace/euw301.Brugada J, Katritsis DG, Arbelo Eet al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC): Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC), European Heart Journal, ehz467, https://doi.org/10.1093/eurheartj/ehz467.Brugada J, Katritsis DG, Arbelo Eet al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC): Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC), European Heart Journal, ehz467, https://doi.org/10.1093/eurheartj/ehz467.Ревишвили А.Ш., Бойцов С.А., Давтян К.В. и др. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств. М. - «Новая редакция» 2017, 704 с. [Revishvili A.Sh., Boytsov S.A., Davtyan K.V. et al. Clinical recommendations for electrophysiological studies, catheter ablation and the use of implantable antiarrhythmic devices. M. - “New Edition” 2017, 704 p. (in Russ.)].Ревишвили А.Ш., Бойцов С.А., Давтян К.В. и др. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств. М. - «Новая редакция» 2017, 704 с. [Revishvili A.Sh., Boytsov S.A., Davtyan K.V. et al. Clinical recommendations for electrophysiological studies, catheter ablation and the use of implantable antiarrhythmic devices. M. - “New Edition” 2017, 704 p. (in Russ.)].Sandler A, Marriott HJL. The differential morphology of anomalous ventricular complexes of RBBB type in lead V1-ventricular ectopy versus aberration. Circulation 1965; 31: 551-556.Sandler A, Marriott HJL. The differential morphology of anomalous ventricular complexes of RBBB type in lead V1-ventricular ectopy versus aberration. Circulation 1965; 31: 551-556.Marriott HJL, Sandler IA. Criteria old and new for differentiating between ectopic ventricular beat and aberrant ventricular conduction in the presence of atrial fibrillation. Prog Cardiovasc Dis 1966; 9: 18-28.Marriott HJL, Sandler IA. Criteria old and new for differentiating between ectopic ventricular beat and aberrant ventricular conduction in the presence of atrial fibrillation. Prog Cardiovasc Dis 1966; 9: 18-28.Wellens HJJ, Bar FW, Lie KL. The value of the electrocardiograms in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med 1978; 64: 27-33.Wellens HJJ, Bar FW, Lie KL. The value of the electrocardiograms in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med 1978; 64: 27-33.Dancy M, Ward DE. Diagnosis Of Ventricular Tachycardia: A Clinical Algorithm, BMJ 1985; 291: 1036-39.Dancy M, Ward DE. Diagnosis Of Ventricular Tachycardia: A Clinical Algorithm, BMJ 1985; 291: 1036-39.Morady F, Shen EN, Bhandari A. et al. Clinical symptoms in patients with sustained ventricular tachycardia // West J Med. 1985 Mar;142(3):341-4.Morady F, Shen EN, Bhandari A. et al. Clinical symptoms in patients with sustained ventricular tachycardia // West J Med. 1985 Mar;142(3):341-4.Morady F, Baerman JM, DiCarlo LA Jr et al. A prevalent misconception regarding wide-complex tachycardias // JAMA. 1985 Nov 15;254(19):2790-2.Morady F, Baerman JM, DiCarlo LA Jr et al. A prevalent misconception regarding wide-complex tachycardias // JAMA. 1985 Nov 15;254(19):2790-2.Chapman PD, Wetherbee JN, Troup PJ. Pseudo P Waves: A Cause of Diagnostic Confusion in Wide QRS Tachycardia // Clin. Cardiol. 1986, 9, 30-32.Chapman PD, Wetherbee JN, Troup PJ. Pseudo P Waves: A Cause of Diagnostic Confusion in Wide QRS Tachycardia // Clin. Cardiol. 1986, 9, 30-32.Kindwall KE, Brown J, Josephson ME: Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. Am J Cardiol 1988;61:1279-1283.Kindwall KE, Brown J, Josephson ME: Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. Am J Cardiol 1988;61:1279-1283.Tchou P, Young P, Mahmud R, et al. Useful clinical criteria for the diagnosis of ventricular tachycardia. Am J. Med. 1988;84:53-56.Tchou P, Young P, Mahmud R, et al. Useful clinical criteria for the diagnosis of ventricular tachycardia. Am J. Med. 1988;84:53-56.Akhtar M, Shenasa M, Jazayeri M, et al. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med 1988; 109: 905-912Akhtar M, Shenasa M, Jazayeri M, et al. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med 1988; 109: 905-912Halperin BD, Kron J, Cutler JE, et al: Misdiagnosing ventricular tachycardia in patients with underlying conduction disease and similar sinus and tachycardia morphologies // West J Med 1990 Jun; 152:677-682.Halperin BD, Kron J, Cutler JE, et al: Misdiagnosing ventricular tachycardia in patients with underlying conduction disease and similar sinus and tachycardia morphologies // West J Med 1990 Jun; 152:677-682.Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83:1649-1659.Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83:1649-1659.Griffith MJ, de Belder M, Micklewright J et al. Multivariate analysis to simplify the differential diagnosis of broad complex tachycardia. Br Heart J 1991; 66:166-74.Griffith MJ, de Belder M, Micklewright J et al. Multivariate analysis to simplify the differential diagnosis of broad complex tachycardia. Br Heart J 1991; 66:166-74.Griffith MJ, Garratt CJ, Mounsey P. Ventricular tachycardia as default diagnosis in broad complex tachycardia. Lancet. 1994;343:386-388.Griffith MJ, Garratt CJ, Mounsey P. Ventricular tachycardia as default diagnosis in broad complex tachycardia. Lancet. 1994;343:386-388.Steurer G, Gursoy S, Frey B. et al. The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia. Clin Cardiol 1994;17:306-8.Steurer G, Gursoy S, Frey B. et al. The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia. Clin Cardiol 1994;17:306-8.Drew BJ, Scheinman MM. ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: practical aspects for the immediate care setting Pacing Clin Electrophysiol. 1995 Dec;18(12 Pt 1):2194-208.Drew BJ, Scheinman MM. ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: practical aspects for the immediate care setting Pacing Clin Electrophysiol. 1995 Dec;18(12 Pt 1):2194-208.

The authors declare that there are no conflicts of interest present.