《2009年ACC-AHA-HRS心电图标准化及解析指南第三部分》内容预览：

    The present article introduces the second part of “Recom-mendations for Standardization and Interpretation of theElectrocardiogram.” The project was initiated by the Councilon Clinical Cardiology of the American Heart Associationand has been endorsed by the American College of Cardiol-ogy, the Heart Rhythm Society, and the International Societyfor Computerized Electrocardiography. This statement waspreceded by 2 articles, “The Electrocardiogram and ItsTechnology” and “Diagnostic Statements,” which were pub-lished previously,and it is followed by statements concern-ing abnormalities of repolarization, hypertrophy, and ische-mia/infarction. The rationale for this initiative and the processby which it was achieved were described earlier.

   The term intraventricular conduction disturbances refersto abnormalities in the intraventricular propagation of su-praventricular impulses that give rise to changes in the shapeand/or duration of the QRS complex. These changes inintraventricular conduction may be fixed and present at allheart rates, or they may be intermittent and be tachycardia orbradycardia dependent. They may be caused by structuralabnormalities in the His-Purkinje conduction system or ven-tricular myocardium that result from necrosis, fibrosis, calci-fication, infiltrative lesions, or impaired vascular supply.Alternatively, they may be functional and due to the arrival ofa supraventricular impulse during the relative refractoryperiod in a portion of the conducting system, in which casethe term aberrant ventricular conduction is applied. Theymay also be due to abnormal atrioventricular connections,which bypass the atrioventricular node, resulting in ventric-ular preexcitation.
In 1985, the electrocardiography (ECG) criteria for intra-ventricular conduction disturbances and ventricular preexci-tation were reviewed by an ad hoc working group establishedby the World Health Organization and the InternationalSociety and Federation of Cardiology. Recommendationswere made for the diagnosis of complete and incomplete leftand right bundle-branch blocks (LBBB and RBBB), leftanterior and left posterior fascicular blocks, nonspecificintraventricular blocks, and ventricular preexcitation.3
  
    The  purpose of the present report is to define the normal QRSduration, review the recommendations made in 1985, recom-mend alterations and additions to those recommendations,and provide recommendations for children and adolescents.

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