Harper R, Hunt D, Vohra J, Peter T, Sloman G
Br Heart J. 1975 Jul;37(7):705-10. doi: 10.1136/hrt.37.7.705.
Seventy-two patients with acute myocardial infarction complicated by atrioventricular or bundle-branch block or a combination of both had His bundle electrogram studies performed during their stay in the coronary care unit. In 19 of the 72 patients a repeat His bundle electrogram was performed before discharge from hospital. These studies demonstrated that 30 of the 32 patients with atrioventricular block and narrow QRS complexes had a block above the origin othe His spike (proximal block). Eleven patients in this group had repeat His bundle electrograms performed before discharge and in 3 patients there was evidence of residual atrioventricular nodal dysfunction. Both the hospital and follow-up mortality in this group was low and there was no evidence to suggest that permanent pacing would benefit these patients. Of the 18 patients with bundle-branch block and a normal PR interval, 9 had prolongation of the HV interval, but there was no difference in mortality in patients with normal or prolonged HV intervals. Twenty-two patients with bundle-branch block also developed atrioventricular block. In 5 of these patients the site of the AV block was proximal and in 14 it was distal, while 3 patients had both proximal and distal block. The hospital mortality in those patients who progressed to second- or third-degree atrioventricular block was considerably higher than in those patients who remained in first-degree atrioventricular block.
72例急性心肌梗死合并房室或束支传导阻滞或两者兼有的患者在冠心病监护病房住院期间进行了希氏束电图检查。72例患者中有19例在出院前重复进行了希氏束电图检查。这些研究表明，32例房室传导阻滞且QRS波群狭窄的患者中，有30例在希氏束波起始部上方存在阻滞（近端阻滞）。该组中有11例患者在出院前重复进行了希氏束电图检查，其中3例有残留房室结功能障碍的证据。该组患者的院内死亡率和随访死亡率均较低，没有证据表明永久性起搏对这些患者有益。18例束支传导阻滞且PR间期正常的患者中，9例HV间期延长，但HV间期正常或延长的患者死亡率无差异。22例束支传导阻滞患者也发生了房室传导阻滞。其中5例患者的房室传导阻滞部位在近端，14例在远端，3例既有近端阻滞又有远端阻滞。进展为二度或三度房室传导阻滞的患者的院内死亡率明显高于仍处于一度房室传导阻滞的患者。
