Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 33(2): 111-119 (2017)


12誘導心電図でここまで読みたい不整脈Arrhythmia that can be identified with a 12-lead ECG

済生会横浜市東部病院こどもセンターChildren’s Center, Saiseikai Yokohamashi Tobu Hospital ◇ Kanagawa, Japan

発行日:2017年3月1日Published: March 1, 2017

12誘導心電図で不整脈が記録されている場合には,まず不整脈の存在を確定する.2 : 1房室伝導が継続している心房粗動や心房頻拍では12誘導を細かく見ることでP波を見つけることが可能になる.またQRS幅の広い頻拍でもP波とQRSの関連をみることで心室内変行伝導なのか心室頻拍なのかを鑑別する.心室性不整脈であればQRS形態からその起源を推測しアブレーション治療の重要な情報となる.また心電図記録中に不整脈がなくても12誘導心電図から不整脈基質を知ることが可能である.不整脈基質に遺伝性不整脈があり,QT延長症候群・QT短縮症候群・Brugada症候群等は12誘導心電図から診断可能だが,カテコラミン誘発多型性心室頻拍の安静時心電図は正常であり病歴と運動負荷心電図が必須である.また器質的心疾患に伴った不整脈(心筋症他)では疾患に応じた心電図異常があり不整脈基質として重要である.

The goals for the identification of arrhythmias using a 12-lead electrocardiogram (ECG) are as follows. The detection of a P-wave at 2 : 1 A–V conduction with an atrial flutter or atrial tachycardia is important. When confronted with a wide QRS tachycardia, it is necessary to determine if the arrhythmia is ventricular tachycardia or supraventricular tachycardia with ventricular conduction delay. The QRS morphology of a ventricular arrhythmia may allow for the site of origin to be determined, which is important information for catheter ablation. Even if there is no arrhythmia in a 12-lead ECG, the proarrhythmic factor can occasionally be identified. Inherited arrhythmias (e.g., LQTS, short QTS, and Brugada syndrome) can be diagnosed with a resting 12-lead ECG; however, in cases of catecholaminergic polymorphic ventricular tachycardia (CPVT), the resting 12-lead ECG is normal. Therefore, an exercise stress ECG and history of syncope are important for diagnosis. Cardiac diseases (e.g., cardiomyopathy) are also important bases of arrhythmia and we can observe abnormalities with a 12-lead ECG, even without an arrhythmia.

Key words: ventricular arrhythmia; supraventricular tachycardia with conduction delay; inherited arrhythmia; long QT syndrome; cardiomyopathy

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