Dhingra R C, Denes P, Wu D, Chuquimia R, Amat-Y-Leon F, Wyndham C, Rosen K M
Am J Cardiol. 1975 Dec;36(7):867-79. doi: 10.1016/0002-9149(75)90075-2.
Twenty-one patients with long-term right bundle branch block and left posterior himiblock were studied electrophysiologically and then followed up prospectively. The group consisted of 19 men and 2 woman aged 61 +/- 2.7 years (mean +/- standard error of the mean). The majority of patients had either hypertensive cardiovascular disease (48 percent) or primary conduction disease (33 percent). Initial electrophysiologic studies revealed A-H intervals of 58 to 152 msec (mean 98 +/- 7.7) and H-V intervals of 40 to 80 msec (mean 52 +/- 2.1). Six patients (29 percent) had prolonged H-V intervals. The follow-up period ranged from 91 to 1,231 days (mean 671 +/-68). Three of 21 patients (14 percent) needed a permanent pacemaker after development of the following symptomatic conduction disease: sinoatrial block on day 3 of follow-up; second degree atrioventricular (A-V) block, site undetermined, on day 118; and second degree A-V block proximal to the His bundle on day 398. One patient died suddenly (on day 571), and two others died of noncardiac causes. In conclusion, combined right bundle branch block and left posterior hemiblock was associated with less trifascicular disease than reported previously. The clinical course of most of the patients was benign and the incidence of sudden death was relatively small. Symptomatic conduction disease occurred but could be definitely related to trifascicular disease in only one patient. These short-term data suggest that prophylactic pacemaker insertion is not routinely indicated in patients with chronic right bundle branch block and left posterior hemiblock.
对21例长期存在右束支传导阻滞和左后分支阻滞的患者进行了电生理研究，并进行了前瞻性随访。该组包括19名男性和2名女性，年龄为61±2.7岁（平均±平均标准误差）。大多数患者患有高血压性心血管疾病（48%）或原发性传导疾病（33%）。初始电生理研究显示A-H间期为58至152毫秒（平均98±7.7），H-V间期为40至80毫秒（平均52±2.1）。6例患者（29%）H-V间期延长。随访期为91至1231天（平均671±68）。21例患者中有3例（14%）在出现以下症状性传导疾病后需要植入永久性起搏器：随访第3天出现窦房阻滞；随访第118天出现部位不明的二度房室传导阻滞；随访第398天出现希氏束近端的二度房室传导阻滞。1例患者突然死亡（第571天），另外2例死于非心脏原因。总之，与先前报道相比，合并右束支传导阻滞和左后分支阻滞与三分支疾病较少相关。大多数患者的临床病程是良性的，猝死发生率相对较低。出现了症状性传导疾病，但只有1例患者可明确与三分支疾病有关。这些短期数据表明，对于慢性右束支传导阻滞和左后分支阻滞患者，通常不建议预防性植入起搏器。
