心電瀑布圖診斷間歌性QRS波增寬的臨床價值

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[中圖分類號] R540.41［文獻(xiàn)標(biāo)志碼]A [文章編號] 2097-5716（2025）03-0409-09 DOI： 10.13308/j.issn.2097-5716.2025.03.019

［引用格式］王晶晶，景永明，申繼紅，等.心電瀑布圖診斷間歇性QRS 波增寬的臨床價值[J].實(shí)用心電與臨床診療，2025，34（3）：409-417.

Clinical value of electrocardiographic waterfall plots in diagnosing intermitent QRS complex widening

WANG Jingjing’， JING Yongming’， SHEN Jihong'，LIU Shichao'， GENG Yiming2，LI Shifeng1（Department of Electrocardiography，1.the Second Affiliated Hospital of Zhengzhou University， Zhengzhou Henan 450O14；2.the Fifth Affiliated Hospital of Zhengzhou University， Zhengzhou Henan 45OO15，China）

[Abstract]ObjectiveTo explore the clinical value of electrocardiographic waterfall plots in the diagnosis of intermittent QRS complex widening. MethodsThe typical cases with intermitent QRS complex widening in ambulatory electrocardiography were retrospectively analyzed.The characteristics of their electrocardiographic waterfall plots were observed and summarized.ResultsDuring intermitent QRS complex widening，the electrocardiographic waterfall plot demonstrated wideningand discoloration of the R-peak band with concomitant T-peak band discoloration. The electrocardiographic patern showing normal P-peak band progression with a PR interval within anormal range wasobserved in conditions suchas intermitent left orright bundle branch block and VAT ventricular pacing.Abnormal P-peak band progresion （manifesting as shift，fragmentation，or absence）was observed inidioventricular rhythms and VVI pacing rhythms；whereas normal P-peak band progression with shortenedPR intervalsoccurred in intermittentventricular prexcitation.ConclusionElectrocardiographic waterfall plotissuitableforrapid diagnosisanddiffrentialdiagnosisof intermitentQRScomplex widening，which could effectively make up for the defects of scatter plot technology in ignoring morphological information.

[Keywords]electrocardiographic waterfall plot；ventricular preexcitation；intermittent bundle branch block; ventricular autonomic rhythm; ambulatory electrocardiography

間歇性QRS波增寬常見于間歇性心室預(yù)激、間歇性束支阻滯、舒張末期室性早搏等情況[1]，室性早搏的散點(diǎn)圖特征明顯、易于鑒別，而室性自主心律[2]與間歇性心室預(yù)激、間歇性束支阻滯這類心電圖的RR間期變化不明顯，散點(diǎn)圖特征不突出，因此非常容易漏診。（剩余8417字）