Stephens M R, Fadayomi M O, Davies G J, Muir J R
Eur J Cardiol. 1975 Dec;3(4):289-96.
Two series of patients with anterior myocardial infarction complicated by right bundle branch block with either left anterior hemiblock (RBBB+LAH) or left posterior hemiblock (RBBB+LPH), have been studied. The first was a retrospective analysis taken from a time when prophylactic pacing wires were not inserted, and the second was a prospective series in whom pacing wires were inserted as soon as the condition defect was seen. The overall prevalence of RBBB+LAH was 3.3% compared to 1.6% for RBBB+LPH, and complete atrioventricular block was seen in 36% of the former and 66% of the latter. From the retrospective data it was apparent that hospital death was usually associated with massive myocardial infarction, although 3 of the 25 patients in this series died in hospital from sudden development of complete atrioventricular block. If the defect was transitory (1-3 days) then the prognosis was that of acute anterior infarction uncomplicated by fascicular block. The policy of prophylactic pacing failed to show any overall change in hospital mortality, and only 3 patients survived long enough to have permanent pacemakers inserted. This procedure has been of benefit to only one of these cases.
对两组前壁心肌梗死合并右束支传导阻滞伴左前分支阻滞（RBBB+LAH）或左后分支阻滞（RBBB+LPH）的患者进行了研究。第一组是一项回顾性分析，取自未插入预防性起搏导线的时期，第二组是前瞻性系列，一旦发现病情缺陷就插入起搏导线。RBBB+LAH的总体患病率为3.3%，而RBBB+LPH为1.6%，前者出现完全性房室传导阻滞的比例为36%，后者为66%。从回顾性数据来看，医院死亡通常与大面积心肌梗死有关，尽管该系列25例患者中有3例在医院死于完全性房室传导阻滞的突然发生。如果缺陷是短暂的（1-3天），那么预后与未合并分支阻滞的急性前壁梗死相同。预防性起搏策略未能显示医院死亡率有任何总体变化，只有3例患者存活时间足够长，得以植入永久性起搏器。该手术仅对其中1例病例有益。
