^ ( )

( )

:\ -

\ -

^ ( )

\ ( )

re-entry

11

, re-entry

jjj) (V7T ( )
Easy ECG
Interpretation Differential Diagnoses

Hans-Holger Ebert, MD

Private Practice
Riesa
Germ any

Thieme


2010
 612.172.4
54.101:53.4 1 ,
-132 , ,


( 1 )

.. ( 1, 2,4), E.JI. ( 3), .. ( 3),
.. ( ), .. ( 5)
, .-.
-132 : , [] / .-. ;
. . ; . .. . .: , 2010. 280 . : . : 17,5 .
ISBN 978-5-98657-020-4.
,
. ,
,
. , 230
, .
, . -
. ,
, .
, , , ,
. ,
, .
612.172.4
54.101:53.4
. .
. .
. , ,

, , , .

. ,
.
. ,
, .
, , ,
, .
, , , , ,
. , ,
, .

ISBN 978-5-98657-020-4 (.) Georg Thieme Verlag, 2005

ISBN 978-3-13-135641-3 (.) , 2010
 ,




Thomas Reimann
.

Hans Volkmann
( Erzenbrigsklinikum
Annaberg-Buchholz) S.G. Spitzer
(
,
, )
.

,

,
,

.

Hans-Holger Ebert
, 2004 .

,
.
, , ?

Hans-Holger Ebert, ,
,
.
, ,
.
.
,
, ,
. ,
,

. , .

Konrad Spang
1957 .:


. Hans Volkmann
.
,
... Erzgebirgsklinikum Annaberg


1 ..............................11 3
.....................................31
1.1 ......................................... 12
1.2 3.1 .......................................... 32
.................................................................... 13 3.2 - .................. 64
1.3 ..............................................14 3.3 ........... 98
1.4 -............................................................... 15 3.4 ............114
1.5 .........................................................16 3.5 .....................................130
1.6 ..........................................17 3.6 .........136
1.7 3.7 ...........................139
....................................................... 18 3.8
1.8 ... 19 ..........................................................142
1.9 ............................................20 3.9 .........146
3.10 ..........................152
2 3.11
............................... 21 re-entry....................................................................161
3.12 ................179
2.1 .......................................22 3.13 ........................ 185
2.2 3.14 ..............................193
...........................................23 3.15 ..........................195
2.3
( ) .............................................................. 24 4
2.4 -............................. 25 ...............................197
2.5 ..................26
2.6 ....................................27 4.1 ..............198

4.2 - 5.4 ...........................235

.... 200 5.5 ..........239
4.3 ............ 205 5.6 ... 240
4.4 ..................206 5.7 .................................................242
4.5 5.8
............................................................221 .........................................243
4.6 - 5.9 ........................................... 245
.....................222 5.10
4.7 Q T .....................................................246
S T ......................................................225 5.11 ,
4.8 S T ........ 226 ............... 248
5.12
5 ................ 227
..................................................................261
5.1 .........228 5.13 ...................... 264
5.2
...........................................232 ...................................................................267
5.3
.............................................................. 234 .......................................269

WPW Wolf-Parkinson-White


-


f



-

10

 1.1

'

12
1.2

13
 1.3

/: 10-20 ,

:
, ,

:
( 50-59% ,
20-38% , 3-30%
)

:

re-entry

14
 /: 1x3x5

:
,
(
)

: -
( 90% ,
1 0 % )

I
:

:
,
(0,2 /)

15
 1.5

/: 10-20

: -,
,

: -
( 90%
10%)

:
-

16
1 .6

: ,

:

:

17
 1 .7

/:

:
- ( -)

:
-

:
;
- re-entry

18
1.8

/:

:
-

:
;
-

re-entry

19
 1.9

/:

: ,

:
re-entry

20


 2.1

( ) \ \
\ **
-
(QRS) ............. ...........

.
1 : 1 .
.

22
2.2

Hh

( )
-
(QRS)

.

( ).

( ) ( . ) .

23
 2.3 ( )

i 1 t 1
( ) \ \ *4 \
-
(QRS)

, ,
. ( ^ )
( \ ) .

II

( ).

;
( .

24
2.4 -

( )
- \ \
(QRS)

-,
.
. QRS
-, QRS .
( \ ) ,

( \ ) .

25
 2 .5

____________________________________________________________________________________
( )_______________________________________________________________________________
-___________________________________________________________________________________________
(QRS) \ ^
QRS ( \ ) .

, ,

26
2 .6

> _ ............. " ..... W

( ) /
- /
(QRS)
*
-
( ).

; ()
( / ), ( ).

( ^ " ) .

27
 2.6

( ) :;
- \ \
(QRS) = ;
re-entry ( t j ) .

(, ) (] [).

()

, re-entry (,
), , re-entry,
( 4 B B v - ) .

: (( .

2 '<
2 .6

, , .

29
 2 .6

.


 3.1

= 51 , RR = 1250

- - , ,
, ,
, , ,
- ( )
60 -

- ,
(, ),

- ,

32
3.1

= 44 , RR = 1350

-
- - 2-
( /)
-

f

33
 3.1

= 50 , RR = 1200

-
- - 2-
2 :1
( /)
-

f

34
3.1

- -

-
-

35
 3.1

2 >

- ; - ,

() ;

-
- ;
>

36
3.1
-

- -
- ,
-

- ,
- - ,
QRS
QRS

37
3.1
-

-
( )
-

f
- -
( )
3.1

v i - *. ^ --------------------- - -------------- ------- 1 --------- ------------- V'

V2 ---------- ------- -------------------

- -
;
, - ,

- ,
-
QRS -
- ST , ,
 3.1

V2
f--------

V3

V4

-
V5
( ), -
2- ( )
-
V6
f
50 / - -

40
3.1

2- ,

- - ,
, , ,
, ,
-
-
-
- < 2 - ,
;

41
 3.1

2- ,

V1

V2

V3

V4

V5 -
- - 2-
( ), -
3-
V6 - - 2-
2 :1
( /)
50 / -

f

42
3.1
2- ,

- -
-
, , ,
- ..
- - (. 5.11 ,
)
- = 2

43
 3.1
2- ,

- -
-
,
- -
-

- = 2

44
3.1

2- ,

III

aVR

aVL

aVF -
- - 2-
( ), -
3-
vi - - 2-
2 :1
25 / ( /)
-

f

45
 3.1
3-

- - ,
, , , ,
,
-
- -
- > 2 -
, ,

46
3.1
3-

aVL -
- - 2-
( /)
- - 2-
2 :1
aVF
( /)
-
25 /
f

47
 3.1
3-

-
- - 2-
( /)
- - 2-
2 :1
( /)
-
25 /
f

48
3.1

- -
; - (
)
-
( )

- - ,

49
 3.1

Q.

X

50
3.1

- -
(
-
)
-
- (
, -)
-
(
,
..)

51
 3.1

-

-
,
aVF

52
3.1

25 /

53
 3.1

25 /

------------------ * ------- --------- * -------- --------- * ;------- -------- ;-------------- *

( ) \ \
-
\

(QRS) I

- - (

- )

-

-

( !)

54
3.1

-
-
(
)
V6

25 /

55
 3.1

= 38 , RR = 1580

- -

- - ,
-
- ,

- -

56
3.1

= 38 , RR = 1580

in

aVR

aVL -
( ), -
2-/-
-
aVF
f
- -
50 /
( )
m

57
 3.1

-
( ), -
2-/-
-

f
- -
50 /
( )

5!
3.1

= 55 , RR =1090

II

aVR

aVL

-
( ), -
aVF 2-/-
-

f
- -
50 /
( )

59
3.1
-

= 55 , RR = 1090

/
V1

V2 ' I ' u

V3

V4

-
V5 ( ), -
2-/-
-

V6 f
- -
( )
50 /
3.1

i , i t ! | ,1

^_

50 /
rf t i f 1' t
( )
-

(QRS) \ \

- -
; ,
- - ,
PQ -
- ,

- - ,
II III -
- PQ ,

61
 3.1

aVR

aVL
-
( )
-
f
aVF
- -
( )
50 /
-

62
3.1

= 66 , RR = 900

V1

V2

V3

V4

-
( )
-
f

V6 I - -
( )
50 /

63
 3.2 -

- 1-

- - - ,
- , , ,

- -
- PQ > 200
- ,
- ,

64
3 .2 -

- 1-

aVR j j> !

-
2 : 1 3 :1
- -

-- 2-
( )
-
50 /

65
 3.2 -

- 1-

V1

V2

V3

- -
V5

-- 2-
( )
-

50 /

66
3.2 -
- 1-

'4
aVR

aVL
1

III Ss aVF
...
\: .

V1 V4
f
j

2 V5
\
11'
:
- -

V3 '

* V6 -- 2- 3-
-

50 /

67
 3.2 -

- 1-

:
- -

-- 2- 3-
-

3.2 -

- 2- ,

50 /
v
( )\ \ VS
N. \ \
\
- \ / \

(QRS) \ / Vi

- - ,
- - , , ,
-
-
-
- PQ - ,
QRS
- < 2 RR -

-

69
 3.2 -

- 2- ,

670 720

( )
-__________________ \_____________n ____________________________ 4 s ^ \____________v ____________\ ___________

- - ,
- - , , ,
-
-
-
- PQ - ,
QRS
- < 2 RR -

-

70
3.2 -
-6 2- ,

- ,
-
- - 2-
( )
aVF - - 3-
- - 2-
-

71
 3.2 -
- 2- ,

mi

aVR

aVL - ,
"V ' -
-- 2-
( )
aVF -- 3-
- - 2-
-
25 /

72
3.2 -

- 2- 2 : 1

- - , , ,
- -
- - ,

- : -
, (
PQ
)

73
 3 .2 -

- 2- ,

- - , , ,
- -
- - ,

- -
- (
- )
PQ
- = 2 RR

74
3.2 -
- 2- 2 : 1

= 84 , = 42

- ,
-
-- 3-
- - 2-
-

50 /

75
 3.2 -

- 3-

- -
- ; -
-

- -
,
QRS; - -,
2-4 ,

76
3.2 -

- 3-

- - ,
-

- -
,
,

77
 3.2 -

(
-_____________ \_________ \_________________\______________ \_____ _________ \_____________ \__

(QRS)______ J| ________________________________________ ^

- - ,
- - , , , ,

-
- QRS; -
(
)
2- ( ) - ,

78
3.2 -
- 3-

mm i .1= 1 ! liliiilii _J1 , L IT

iilii -r:--1
.:
III f i liiiiii II! :::::::: !
mJ ! 1 1:
pljjjj^r i i :.!ii j ;: 1 i l t l 1
i i p i iii m iilii! . 1 L III
j 4- !

( )
-
V \ \ \ \ \

(QRS) ^ ^

- - ,
- - , , , ,
-
-
-
, -
QRS; (
)
QRS - ,

79
 3.2 -

- 3-

= 90 , = 40

- ,
-
-- 2-
( /)
- - 2-
-
3.2 -
- 3-

= 90 , = 40

V1

V2

V3

- ,
V5 -
-- 2-
( /)
- - 2-
-

50 /, QRS = 100

81
 3.2 -

- 3-

17
1 ::
J L---- :
:\: iI
J i

1-
:
*?? - !;!|

( ) \ \ \ \ \
-

(QRS)
....... %

- - ,
- - , , , ,
-

- -
, - ,
QRS;

QRS

12
3.2 -

- 3-

= 100 , = 42

aVR

aVL
-- 2-
( /)

- - 2-
aVF
-

25 /, QRS = 140 mc
 3.2 -

- 3-

= 100 , = 42

-- 2-
( /)

- - 2-

-

25 /, QRS = 140

84
3.2 -

- 3-

= 170 , = 44

-- 2-
( )

- -

(
)
25 /

:5
 3.2 -

- 3-

50 /
-h i

( ) X
-
(QRS)

- - ,
- - , , , ,
-

- -
- , (
)

16
3.2 -
- 3-

II

III

aVR

aVL
-
( )
-
aVF

50 /

3.2 -

- 3-

- - ,
- - , , , ,
-

-
- ;
;

,
3.2 -

, -

- - ,
-
-

-,
- - ,
- QRS - ,
- < 2 RR

3.2 -

, -,
- 1-

-- 2-
( /)
- - 2-
-
3.2 -
-

-- 2-
( /)
- - 2-
-

50 /

91
 3.2 -
-

- - ,
-
-

- ; -,
-, - ,
- ;

92
3.2 -
-

V2

V3

V4

- , -
V5 - ,
-
- -
3-
V6 -

50 /

93
 3.2 -

= 32-51

f f f t t f ft t ft? f t t t f t t t t tt ff ft ft
( P) H * 4 4 + '
- MMK MMM MM\ MMMMMMMMMMMM MM
\ ( ...1 1

(QRS) M M

- - ,
-
- (. -)
- f
- ,
-

94
3.2 -

= 38

- , -
-
-
-
-
3-

25 /

95
 3 .2 -
-

f f f i t f f f f i f f f f f f t f f f f t t t J + t ft
(
-

(QRS)

- - ,
-
- (. -)
-
- ,
- f -

96
3.2 -

( ) ^ 1^.
- ^ ^ ^ i ^ ^ \ ^ ^ ^ % \

(QRS) \ \

- - ,
-
- (. -)
-
- ,
-

97
 3.3

50 /
( )
-

- , -,
() -
( ;
( ) ,
- QRS >0,12 ; )
( ST )
- - ;
- QRS: V1/2 rSR, V 5 /6 -q R S , S
, R 40 I V6
- > 0,05 (50 ) V1

98
3.3

-

-
- W PW

50 /
 3.3

aVR

-
aVL

-
- WPW
aVF

50 /

100
3.3

III

aVR

-
aVL

-
- WPW

aVF

50 /

101
 3.3

50 /

( )
-_______________
(QRS)

(QRS)

- , - ,
() -
( ;
( ) ,
- QRS 0,11-0,12 ; )
( ST )
- - ;
- QRS: V1/2 - rSR, V 5 / 6 - qRS
- > 0,05 (50 ) V1

102
3.3

-

-
- WPW

50 /

103
 3.3

V1

V2

V3
ill

V4
aVR

aVL
-

-
V5 - WPW

aVF V6
50 /

10 4
3.3

- 1-

- - ,
, () - (:
; :
, ,
)
- (. . 98)
PQ > 0,20 - ;

10 5
 3.3

- 1-

-

-
- WPW

50 /

106
3.3

- - ,
-
( , )

- - ;

10 7
 3.3

III

aVR

aVL
-
( )
QRS


aVF

25 /

108
3.3

V1

V2

V3

V4

V5 -
( )

QRS
V6

50 /

10 9
 3.3

( )

Ml
,= :

" , :

:
:
~
; f
* _/
h ! m W

25 /

( ) t i t! ^ i i '
Ilia v fY V V
^
- * N J r V %
| (QRS)
| (QRS)
|\| N

> *

V. \

- -,
-
( , )

- - ;
( --),

110
3.3

( )

in

aVR

aVL
-
( )
QRS

25 /

111
 3.3

- * hJ, >
(QRS) . . . .' . _
. . ..V . ... ..............................................

- - ,
, () - (
;
, )

- / - ,

- ,
-
-

112
3.3

-
(
)
QRS

50 /

11 3
 3 .4

- - , ( ),
, , ,
, ,

( ) - ,
-Q R S > 0,12 ;
( ST ) -
- () ;
-
- QRS: V1/2 - Q S , V 5 /6 -
R', R ;
l/aVL, q I, V5/6
- > (< 35% )
0,06 (60 ) V5/6 -

114
3.4

:
-
3 :1
- -
- - 2- 3-
-
50 /

11 5
 3 .4
- 1-

j
.
;
...;;:.

i i l l i | | | | | I I J i

:;;.;;;: :: | .
50 /
1
( )
-
\ V
(QRS) V v
(QRS)
................... \ .... ................... \ ................. .

- - , ( ), ,
- , , ,
,

- ,
- ()
.

-
-

116
3 .4
- 1-

II

III

:
-
3 :1
- -

-- 2- 3-
-

117
 3 .4
- 1-

V1

V2

V3
I

'R

I* '

i
:
-
\ 'F 3 :1
L-i
tHf? - -
-- 2- 3-
-
50 /

118
3 .4

- 2- ,

- - , ,
-
- ,
-
-
- (
)
-
- PQ
- = 2 RR

11 9
 3 .4

-
()

- - , ,
-
- ,
-
- QRS; -
- (
2- ( ), )
- - ,

120
3 .4

:
-

- -
-
,
50 /

121
 3 .4

50 /
( ) I
I- I
(QRS)
1* J>

(QRS)
________ %>___________ % ___________ % ________

- - , ( ),
, , ,
, ,

- ,
-
-
- - ()
.

122
3 .4

:
-
3 :1
-


50 /

123
 3 .4

( )

-
(QRS)

(QRS)

- -,
-

- ,
-
( --),

124
3 .4

( )

III

-
( )
QRS



25 /

125
 3.4

- - , ,
, ,
, ,
,
- QRS < 0,12 ;
( ST )
- - ,
( -45 -90)
- QRS: S V6, R
I, aVL
- > 45 aVL

126
3 .4

-
-
-
-
- WPW

12 7
 3 .4

II

III

- * N

* S I
, (QRS) V

, (QRS)
% \ ....... V

- - , ,
, , , ,
,

-Q R S < 0,12 ;
( ST ) - ,
-
( 90 180)
- QRS: Q V5/6, rs rS
I, , aVL, qR III, aVF

12 8
3 .4

-
i -
-
-
aVF ---- ~----- |------ V6 ------ ----- v/ - WPW

50 /

12 9
 3 .4

-
-
-
-
- WPW

130
3.5

()

131
 3.5
- 1-

-- 1-

-- 1-

50 /

132
3.5

-


-



50 /

133
 3 .5

- 1- ,

II

III

aVR

aVL

-
aVF
-
1 -

50 /

134
3.5

- 1- ,

V1

V2

V3

V4

V5
-

-

V6

50 /

13 5
 3 .6

- - : , ,
re-entry ,
- - - :

- ,
- (
) -
- -
QRS

136
3.6

137
 .

( )
-

13 8
3 .7

^ f + I +
( )
4> + <> +

- \ \ \
\
(QRS) ^ %

- - , , ,

- , -
: ( 7 0% , 30% )
- ( 1C III)
- (-,
, )

139
 3 .7

RR ()

( )

-
(QRS)

- -
RR ( , 100-250
) - 1 : 1
-
RR ( , - II, III aVF
)
- PQ ,

I aVL

140
3 .7

( )

= 147 , = 147

-
- -
re-entry
-
WPW
-

50 /

141
 3 .8

() U U U O O U O U U O U O O U U U O O U O O
-

(QRS) \ \ \

- Re-entry - : , ,
(, , ,
, , - :
, )
- -
-
- : -

- -
200 300

142
3 .8
- ()

= 240 , = 120 2 : 1

-
-

- -
re-entry
aVf V6 -
JU WPW
25 / -
-
 3 .8
- ()

= 216 , = 108

-
-

- -
re-entry
-
WPW
-
50 / -

144
3 .8

-
( )

= 208 , = 104
-V ACT ,
1 /L ~ j U
I rTT[~

hi

aVR

-
-

aVF - -
re-entry
-
WPW
50 / -
-

145
 3 .9

- 2 : 1
( )

( ) 0<J0U<JU0U<J0UUUU0
-

(QRS) \ \ \ \ \ \ \ \

- re-entry - : , ,
; ,
- :

- : - /
II, III
- -
- 250 -
350

146
3 .9

-
( )

-
-

--
re-entry
-
WPW
50 / -
- /re-entry

14 7
 3 .9

- 1 : 1 ,

-
-

-
WPW
-
WPW

/

148
3 .9

-
( )

( )
-

(QRS)

- re-entry - : , ,
; ,
- :

- : ( - /

) II, III -
- -
250-350

14 9
 3 .9

-
( )

= 340 , = 170

V 1

: V2
? V
|
V:
-w.

1 T
V3 _

4 - 1 i }

: ~ ' t 4

aVL
V5 -
1 ~ 1 :i ~
ill:::-! j V." l
I ; -
if, - -


--
_ aVF . re-entry
*

I - - ' ]
-
wmm V
WPW
50 m m / c - /re-entry

15 0
3.9

-
( )

151
 3 .1 0

- re-entry - ,
f
- - ,

- ( RR)
-
-

- ; , , - :
( , ),

, - |
(
),
- ! , - :
, ,
, ,
, , /
- :
( )

152
3 .1 0
,

: < 50 , :
< 1 - - ( )
( < 7 ) - (,
: )
( ) - (, )
: -
IA, IC III :
: - -
( ):
- IC ( -): - -


- :

- :
- II (-)

153
 3 .1 0

: ( CHADS2)
48
/ 2
:
> 75 1'

1
3 2 ,0-3,0
( 2,5); 1 .
1
.
:
( 2,0-3,0, 2,5)
( ,
!)

81-325 /

1 81-325 /


( 2,0-3,0,
:
2,5)
, , ,

:
> 75 , , ( 2,0-3,0,
, < 35%, 2,5)
1
: ,
65-74 , ,

Nach Fuster et a!. ACC/AHA/ESC 2006 Guidelines for Management

of Patients With (J Am Coll Cardiol 2006;48:854-906)
15 4
3 .1 0

- re-entry -
;

- - : ,
- 60
-
-
RR -

- . - : /,
, , -
- :
-
RR - 48


- ( IC III),

15 5
 3 .1 0

-
-

--
re-entry
-

15 6
3 .1 0

= 190-200

-
-

- -
re-entry
-
re-entry
WPW
50 / -
m

157
 3 .1 0

1 1
! .i
I I . [ , j::;
' V fat \l /
-i I: I:-1 > j |_
-

4- - .
|1
' 4 : F <* * I
~~^fW -
. I ! I I I I I : !'
-

~1
: i "II

50 /

_____ * ++ + + ++++++++ +++

( )*
-____________
(QRS)

- re-entry -
- : , ,
- ,
- - :

- -

RR
- f ;

-

158
3 .1 0
,

- - ( )
- - :
-
- - : -,
-

- - -
- :
- f , ,
- RR
-

15 9
 3 .1 0
-

________________________ _____ _____ _____

+ a m i
( ) \ \ \ \ \ + 4 *
-
(QRS)

- -
-
-
- - -
- -1 -
- -
RR
( )

160
3.11 re-entry

- re-entry ( )

( )

( ^ )
( \ )

(QRS)

- -
( \ ) ;
(
)
( );
- :
( -
( -_), )
- :
re-entry ( IC, III, IV) m
- : 12-18
161
 3.11 re-entry
- re-entry ( )

- re-entry -
;
QRS
( (rSr V1)
QRS); re-entry

-

16 2
3.11 re-entry
- re-entry ( )

= 176 ,
RR = 340

I ! iii

-- *-
b J.iJ
II 1 ;{

III
III

aVR aVR

: , j/jv T ;
!
P
aVL -
4VL , re-entry
WPW
--
aVF re-entry
aVF ; ( )
jiJjh-L:.
-
( 2 :1 ; 1 : 1)
50 / -

- /re-entry
163
 3.11 re-entry
- re-entry ( )

= 176 ,
RR = 340

V1

V2

-
V[5
re-entry
WPW
--
re-entry
V6 ( )
-
( 2 :1 ; 1 :1 )
50 / -

- /re-entry
3.11 re-entry

- re-entry ( )

-
-
-

-
WPW
 3.11 re-entry
- re-entry ( )

= 240 , RR = 250

50 /

( )

( \ )

(QRS)

- - - -
re-entry,
( ) (
, )

-
( )
- - ( IC, III, IV)
; () - : 12-18
QRS (
PR < RP)

166
3.11 re-entry

re-entry WPW

= 182 , RR = 330

- -
, ,
-, ,

re-entry - :
- (.
- WPW)
- : 12-18
- ()
QRS ( PR > RP)

167
 3.11 re-entry
re-entry WPW

= 187 , RR = 320

- () W PW = -

- ()
- QRS ( PR > RP)
(
-); . . 167
-
- . . 167

m ,
-
168 re-entry
3 .1 1 re-entry
re-entry WPW

--
re-entry ( )
-
( 2 :1 ; 1 :1 )
-

- /re-entry

169
 3.11 re-entry

re-entry WPW

RR = 300 RR = 300

- , -
, (
QRS; )
-
-
,

17 0
3.11 re-entry

re-entry
WPW,

= 139 , RR = 430 = 164 , RR = 360

RR ,
1. , .
, 2.
QRS. ,
re-entry;
, , RR ,
(
,
, re-entry , )

171
 3.11 re-entry

re-entry WPW

= 139 , RR = 430 = 164 , RR = 360

17 2
3.11 re-entry
WPW

= 200

H i I I
25 /

( ) > < } > < < > > < > < |> ^ < > < 3 < >

- ()()
( ()
UHU { { { [{{{

(QRS) ^ \ \ \ \ \\\\\\\\\\\\\

- -


; - :
! - ( IC, III,
)
- - :
, (. )

173
 3.11 re-entry

WPW

- torsade de pointes
-
-
- ( )
- (

50 /
)

17 4
3.11 re-entry
re-entry WPW

( )

- ( !
( : :)

(QRS)

- - -
;
- ( )
re-entry
- :
- - ( IC,
III, )
- : 12-18

175
 3.11 re-entry
re-entry WPW

= 167 , F 360

aV R

-
-

aVF

W v -

50 /

176
3.11 re-entry

50 /
( )

- ( )
( ? )

(QRS)

- re-entry -
- ()
-
- :
- ( )
- (.
- QRS WPW)

177
 3.11 re-entry

re-entry

= 141 , RR = 425

-
-


-
re-entry
WPW

178
3 .1 2

- , re-entry -
re-entry (, -
..)
-
-
QRS
(2 RR)
-

17 9
 3 .1 2

( )

(QRS)

18 0
3 .1 2

( )

(QRS)

181
 3.1 2

( )

(QRS)

-J.j ;HI_Jj__

1 1 J 1 ' iliip :
eimm_
4
* | "
^ ' I

1
I y:jrf

~ " ^
i i i

ill

------------------ ------------------ f --------------------- --
1 v- / \ / / / /
- \
(Q RS) \ ^
V .......V ..................... \

182
3 .12

( )
-
(QRS)

( )

(QRS)

183
 3 .12

0
I 30

II 30

IIIA

IIIB
IVA
IVB
(> 3
) )
V R-- (
)
184
3 .13

= 139 , RR = 430

V

V2
V
4. V 3 ^ \ .
v f r -----

-. * V 1
( ) \ \ \ \

- \
(QRS)

- -
-
- ( IB, )
re-entry
-
- QRS -
-
,

185
 3 .13

,

()

-


- QRS
-
( )
- V 1 : QS ( )
- R II III
- R rS I

( )
- re-entry

- - QRS
- , 120
- QRS -
-
-
- ( )
( )

186
3 .13

= 272 , RR =220

aVR

-

aVL -

-



50 /

187
 3 .13

V3

V4

V5
-

-

-

188
3 .13

= 154 , RR = 390

- -
(, -
, / ..)
- - (
- )
- (/ )
- ;

-

189
 3 .1 3

RR = 390

-

-

-

50 /

190
3.1 3

- -

191
 3.13
torsade de pointes

------------------------------ --------* -------- -------- -------- -------- -------- -------- -------- -------
___________ ______ \ ______ \ ______ ______ ______ ______ \ ______ ______

<)
(QRS)
V V V V V V V V.V

- / -, ,
QT -
-
-
( .. )
- - -
- -
-

192
3 .1 4

( )
-
(QRS) *1 ? 1 o l

- re-entry? -
- ? - ()

-
- (
- )
- 240-300
-
- -
;

193
 3 .1 4

= 300 ,
RR = 200

-
-


-
W PW
- re-entry
50 / 50 /

194
3 .1 5

( )
-
/ | E, ....

1 .... I 1............ " ..................... 1

- re-entry? -
- ? - ()

-
- (
- )
- > 300
-
- -
;

195
 3 .1 5

/ \ /\ /\ V1

II

ill

aVR
aVIv W IA^
aVL
vwvW\/\a/V\/ V5 -
-
1 :1
WPW
aVF / V ^y% w W W V 4*A A V6

19 6



 4.1

() [1]
: ,
, -
:
- :
: [2]
[3]

[4]
- :
[5]
(1-3) [6]

() [7]
: ,
,
, , -
:
- : [8]
- : [9]

198
4.1

( ) [1]
: ,

:
- : [2]
- : [3]

() [4]
: ,
, -
:
- , : [5]
- , : [6]
- :
( )

199
 4.2 -

- - , ,
() .

- : 4TKA/AKLU
. -: , -,
, ,
.

200
4.2 -

- ST
( 0,1
, 0,2 )
-
()

201
 4.2 -

V1 V1

V2 V2

V3 V3

V4 V4

V5 V5

V6 V6

- ,
- ,
- , WPW
Q l"
ib V4
- , V1 STV3

20 2
4.2 -

20 3
 4.2 -

; ,1 -0 ,3
! 0,8

0,2
0,1

III

- ST
( I 0,1
, 0,2 )
-
()

204
4 .3

/ , ,

-- -
( )
' ;i

ST
- ST
(
)

I
+
+ . -
I I

ST ST
I

:
4-
+ + +
= / + GP lla/lllb , -,
(+ GP / ,
?)
=
=
+ GP lla/lllb

, (9-12 ), , -,

* .

20 5
 4 .4

- : -
( Q)
- : - ST:
ST
; >0,1
, > 0,2 ,
, ST

- :
-
( ) - , , ,

- , , - ,
(, -, ,
) - ,
- , 2 3
- ,

- : ///
- : , -
, ,
-

- -,
- ,
-

206
4 .4
:

1.
(
1

2. ST
( ,
4- 2-3

3. ( )

* - 4-6

4. Q ( )
6

5. ST ( ) N t , 2-3
6 . ( ) 4 \|
\ / J \ 4
\|

207
 4 .4

.

;

Q.

208
4 .4

ST

() .
, , ,
, .
ST.
,
. ST,
, ( ST

,
). ST . 224

209
 4 .4

,
,
.
> 0,5 V2-V4(5)

210
4 .4
.

- : I, II, V2-5

- (
)

211
 4 .4

aVR

aVL

aVF 1

- : (I, II), (V1), V2-4

-

21 2
4 .4

- : I, (II), aVL, (V1), V2-5, (V6)
- ST


-

21 3
 4 .4

- : I (II), aVL, (V1), V2-5, (V6), NA, NI

-

214
4 .4

- : I, aVL, (V3)4-6

-

215
 4 .4

- : II, III, aVF, V5-7

-

216
4 .4

'I

;|wm
1


I
1
"!
___

- : aVF, V8-9

- V2

217
 4 .4

V1

V2

III Vr5

aVR
V7

aVL V8

aVF V9

- : II, III, V(6)-7-9
- rV3-rV5

-

218
4 .4

V1

219
220

4 .4

4 .5

15

221
 4 .6 -

-

- ST
V3-5
(
)

22 2
4 .6 -

22 3
 4 .6 -

V 3L1__________| _______

\
V4

-
(III)
- ST

(I, V3-5)

224
4 .7 ST

-
ST
,
- J
( QRS
ST)

J ( )
< 40 V2-3 > 0,25 , > 0,1
> 40 V2-3 >0,20 , > 0,1
V2-3 > 0,15 , > 0,1
/ V7-9 > 0,05
/ VR3-VR4 > 0,05

I ( )
/ V2-3 > -0,05 , > -0,1

: ST > 0,1 8 ST aVR/V1

.

22 5
 4 .8 ST
ST

-
ST > 0,1
(. . 225) QRS (
- ST)!
() ST> -0,1 m B b V 1 -3

S ( ST)!

ST > 0,5
QRS (
ST)!

226

 5.1

' | I

:




,



-

- QRS (QRS 0,11 ;

V5/6 > 0,05 ),
q

- R/S (. )
-
( ,
ST), QT
-
!
50 / -

35 (. )
- ST

-

228
5.1

- (S V1 + R V5 > 3,5 )
25-43% , 95%
- (R I + S III - R III - S I > 1,7 )
- (R aVL + S V3 > 35 )
- -:
(R S
> 2,0
S V1-3 > 2,5 , R V4-6 > 2,5 ) 3

( -30) 2
ST-T 1-3
QRS
(> 0,09 ,
V5/6 > 0,05 ) 1
(P-mitrale) 3
5
5 0-55% ; 95-98%

- , , , -
, -
, - ,
(, , -
)

-

229
 5.1

( (
) )
- R - Q 1, aVL, V5-6
- - R V1-2
( ST, V5-6) - V5-6

(

&

V1/2 V5/6 V1/2 V5/6

'IT ~
230
5.1

-
-

- :
QRS > 160
S V1/2 + R V6 > 4,5
(
)

III

aVR

aVL
V5

aVF

V6
50 /

231
 5.2

- 1 , 1 1 , 1 4 15
,
(> 200 )

-
(. 5.1 )
-
(
)

-
, ,

,


- ,

,

-

- -,
()
-
-:
,
- ()
- -


232
5.2

-
-
- ,
-
( )

23 3
 5.3

- ,

,



- ST ( 40% )
- II, III, aVF
(10-40% )
III
- QT
-

-
( - )

V5 - :
- :
( )
- :
- -
- (
V
)

234
5 .4

- (, , ,
)
-
( )
-
-

- ST
S (
)
- ,

-


-

-


-
-
- ,

23 5
 5 .4

-
-
-
-
-
-

236
5 .4

-
-
-
-
-
-

in

237
 5.4

-
,


-

-:
(
), -, -

- , , (
Borrelia), , ,
-
-

-
-
- ,

238
5.5

-



-


- P-pulmonale (
II, III > 0,3 )
- -
(RV1 + SV5 > 1,05 )
-

-

- (
,
,
, ..)
-
-
50 /


-
in

239
 5.6

-




-

- Sl-qlll
- S V5 V6
- ST
III, V1-3
- P-pulmonale
-

,

-

-
-

240
5 .6

-


-

50 /

241
 5.7

-

-
- R
,
rS
-

V4

-

V5_. -

aVf

24 2
5 .8

-
,

-
( ,
)
- ,

-


-
(V1-3)
- , -
( QRS)
- (
)

- ,
, -
- .

24 3
 5.8

-
-
-
-
-

244
5 .9

V1

V2
\

V3

V4

V5 s A j
- SCN5A
( )
V6

- :
1: ST J
ST > 0,2 V1-2 (V3),

2: ST >0,1 ,

3: ST <0,1 ,

-
(, , )
- ( ,
50 /
)

-
- - in
( ,
)
24 5
-
5.10 QT

-:

(5 )
- :


- QT
-
- U
-
(Torsade de pointes)

-
-,


- -
5.10 QT

QT
- - (-
, )
- --
(- ,
)

QT
- :
IA ()
III (, )
-
-
- ,
-
- ,

- !!!
-

247
5.11 ,
IA (, )

IA
, ,


-
,
( 0),
1 (
) 4
,

-

-
-
- QRS
- ST
- QT
5.11 ,
IA (, )

50 /

249
 5.11 ,
IB (, )

IB
, ,

-
-
-
( I)

-

250
5.11 ,

IC (, )

iJ - IC
, ,

- ,

( I);

-

- PQ
- QRS
- PQ

50 /

in

251
 5.11 ,
IC (, )

QRS ( S)

25 2
5.11 ,
II (-)

I ft V1
-
-1-

II -
,
III

(
i V3 )

- ,
aVR
- 1 -
- ST

aVL |\
\

50 /

25 3
 5.11 ,
III (, )

III
, (,
)

- :
D- ( III
)
L- ( II,
- )

- 3
( ),


-
-
QT!

- QRS
ST

254
5.11 ,

25 5
 5.11 ,
III (, )

III
, (, )

-

III

-
3 ( )
-
1
-
-

- -

-

-

-
;

-

256
5.11 ,

III (, )

-
- PQ
- QT
- QRS
ST

-
()
- ( 3
!;
)
- ( )
aVR -
()
()
- ,

aVL
( , )
-
(,
)
aVF
- (, )
- , (, )

257
 5.11 ,

-
(1)
-



-
( )
-


- ,
-


-

re-entry

-

258
5.11 ,

-

- -1 -,


(
)

-
- PQ
- ST,

50 /

259
 5.11 ,

-


- ---,


-
-

- ST

260
5.12

-
, ,
- ,
( ,
, ),

-
-

-

- /
-
- 3
-

- QRS

I 1 1I \ 4 \

- ST
- QT
- U

261
 5 .12

- ,

- ,
-
-


-

- /
-

- 3
-

-

( )
- QRS
- ST
- QT
( QRS
)

26 2
5 .12
/

- -
( , , ),
, , ,
,

- 2

- QT
( )

- ,
D

- 2

- QT
( )

263
 5 .13

P-pulmonale P-mitrale

50 /


, ,

-


-
II, III > 0,3 I II > 0,11
-

sine :0;35
0,14

0,05
I, II
-
> 0,03
-


V1 > -0 ,1 5

264
5 .1 3

P-biatriale


,


- II, III > 0,3
- > 0,11
-
-
V1

in

V1

26 5
 5 .13

,
,
,
-

- > 0,11
- -
II, III
-
aVR V1
-

PQ

50 /

V1

266



Block , et al. Richtlinien fur die Durchfuhrung der nicht invasiven AHA/ACCF/HRS Recommendations for the Standardization
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Braunwald E, et al. Essential Atlas of Heart disease, Philadelphia: A Scientific Statement From the American Heart Association
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Cosio FC, etal. Living Anatomy of the Atrio-ventricular Junctions, on Clinical Cardiology; the American College of Cardiology
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Crawford MH, et al. ACC/AHA Guidelines for ambulatory Elec
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Gibbons RJ, et al. ACC/AHA/ACP-ASIM Guidelines for the Part III: Intraventricular Conduction Disturbances
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diol 1996; 85: 611-627. Part V: Electrocardiogram Changes Associated With Cardiac
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1988.
Schlandt RC, et al. Guidelines for electrocardiography, JACC
1992,19: 473-481.
Singer I, et al. Interventional Electrophysiology, Baltimore: Wil
liams & Wilkins, 1997.
Zipes D, etal. /AHA Task force report: Guidelines for Clinical
intracardiac Electrophysiological and Catheter Ablation Proce
dures, JACC 1995: 26: 555-573.

268



P-biatriale 265 78
P-mitrale 264 120
P-pulmonale 264 82-85
QRS 25, 26 85
Re-entry 28 79-81
R-- 184 -
ST , 209 37
Torsade de pointes 192 38
WPW -,
168 - 3- 79-81
167 57, 58
173, 56
174 3- 46-48
-
13
- 25
1- 64-68
97
134,135 96
67, 68, . -
116-118 - re-entry
105,106 166
134,135 161-165
133 165
2- 69-75 258
2 :1 73, 75 256, 257
69-72 , 213
74 248-257
119 IA 248, 249
3- 76, 77 IB 250
86-88 IC 251, 252
, II 253
88 III 254-257
, re-entry
76, 77 177,178

270


W PW 175,176
243, 244 124,125

198
199 102-104
199 108,109
198
219
131,133
- 259 98-101
- 253 134,135
112,113
191 - 1- 105,106
107-109,148,170
180 re-entry
181 WPW 170
137 108,109
131,133 110,111
107-109
220 159
.
- re-entry 165,166 94
231
128-130
126,127 253
, 203
121 ,
69-72
- 1- 67, 68,116-118 41,42
- 2- , 119 266
re-entry
WPW 84
- 120
122,123 , 128-130
114,115


- 1- 132
131,133 -
133 1- 65-68,106,132,134,135
134 2- 71, 72, 75
126,127 3- 80, 81, 83-85, 87
262 - 38
263 - re-entry 163-165
232, re-entry
233 178
re-entry
228-231 WPW 176
229 244
231 131,133
230 115,117,118,121,123,
239 125,127,129
230 99-101,103,104,106,
261 108,109,111,113,131,133-135
263
129,130,135
183 127,131-134
138 233
- 92, 93 229
184 187,188,190
188
134,135, 222
242 90
93
26 62, 63
26 re-entry
24 WPW 169
265
145 57, 58
-- 247 52, 53, 55
230 236, 237
243, 244 141

27 2


- 179
59, 60 182
186
2- 42, 45 184
3- 47, 48 183
33, 34 184
- 202, 222 180
194 26
143-145,147,148,150 183

40 3
196

95 - 3- 82-85
156 85
121,123,125 -
111,113 - 3- 79-81
157
W PW 174 57, 58
241 56
3- 46-48
39,40
186-191 39, 40
186-188 Q, 208
187 23-25
264-266
186,188 162,166-168
186

185 182
185,189 .
189-191 210
179-184 198-226
180,181 216
181 217-219

273


221 184
219
218 36
185
194 198
ST 209 198
210
206-220 183
211, 212, 220 138
212 - 91
215
211, 213, 214
- 222-224
torsade de pointes 192
220 -
134,135 1- 64,105,116
- 3- 76, 77 2- 69, 70, 73, 74,119
Q 208 3- 76, 77, 79, 82, 86 88
207 78,120
() - re-entry 161,166
205 re-entry
, 221 177
- 199-204 re-entry
202, 204 W PW 175
204 243
202 114,116,119,120,122,
203 124
203 98,102,105,107,110,
. 112

128
50,154 126
154 232
167,168 229
171,172 239

274


185,189,192 158,173
179 240
206
238 /1
89,92,136 178
92 250
61 235-238
re-entry 12
W PW 167 265
51, 54, 56 ,
205 74
235 116
139 43-45
234
245
QT 246 137
138
2- 41, 44 - 92,93
3- 46 137
35
32, 37 136
- 200
193 107-109
142,146,149 108,109
36
39 - 89, 90,92, 93
195 - 1- 90
155 92, 93
94 28
49 138
122,124 - 91
110,112 27
- 96,97 131,133
159 266
- 160 . -; ;

275


; ; 139-141
141
, - 3-
51-53 85
61-63, 266
16,17 ,
. ; 97
,
96
- 25
28
13,19 182
13, 20 182
13,18 182
199 22, 23
re-entry , 13
WPW 167-172 234
13,16
172
171
171,172 59,60
WPW 168
WPW 167 182
170 182
-
57, 58 59,60
- 247
51-53
54, 55
56 260
205 259

W PW 167-176
235-237 219
245

276


-- 247 re-entry
54, 55 177,178
205 WPW 175,176
234
- 247
QT 246, 247 187

2- 41-45 186,188
41,42 186
43-45
3- 46-48 185
47,48 185,189
32-34 189-191
- 37 re-entry
32-63 W PW 167-172
38-40 171,172
14 W PW 168
13 WPW 167
170,171
49 172
23
39,40 141
230 139-141
254, 255 - 3- 85
27 121,
- . 157,158, 173,174
() 193,194
194

-
torsade de pointes 192 142-145
- re-entry 143,144
166
161-165 145
165 -

277


149,150 W PW 173,174
146,147,151 251,252
1 :1 148
2 :1 146 X
12 248, 249

180
137
189-191
189
195,196

94,95 ,
-
49 1- 64,105,116
215 2- 69, 70, 73, 74,119
155 3- 76, 77, 79, 82, 86, 88
153 78,120
153 - re-entry 162,166
153 re-entry
154 177
50,153 re-entry
153 W PW 175
156 243
159 114,116,119,120,122,
124, 231
121 98,102,105,107,110,
122,123 112,170
124,125
128
112,113 126
110,111 262
- 96,97 263
- 160 232
121,157,158 228, 230, 231

278


239
261 2- 41, 43, 44
263 3- 46
242 35
185,186,189,192 32, 37
179 - 201, 204, 224
264-266 torsade de pointes 192
, 193
248-260 142,146,149
258
39
IA 248, 249 195
IB 250 152,155
IC 251, 252 94
II 253 49
III 254-257 122,124
- 259 110,112
260 215
185, 211-218, 224 - 96,97
159
36 - 160
238 158,173
89,92,136 240
92 . ;
61
re-entry ,
WPW 167,168,170 28
51, 54, 56 28
205 208
235 50,153
140 , 240, 241
234 110,111,124,125
245
234
QT 246

27 9


:
,

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.: (495) 689-62-64, : (495) 689-31-24
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