希氏束内阻滞。临床、心电图及电生理特征。

Intra-His bundle block. Clinical, electrocardiographic, and electrophysiologic characteristics.

作者信息

Andrea Eduardo M, Atie Jacob, Maciel Washington A, de Oliveira Nilson A, Camanho Luiz Eduardo, Belo Luís Gustavo, de Carvalho Hecio Affonso, Siqueira Leonardo, Saad Eduardo, Venancio Ana Claudia

机构信息

Hospital Universitário Clementino Fraga Filho - UFRJ, Instituto Estadual de Cardiologia Aloysia de Castro, Rio de Janeiro, RJ, Brazil.

出版信息

Arq Bras Cardiol. 2002 Nov;79(5):526-37.

PMID:12447503

Abstract

OBJECTIVE

To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS).

METHODS

We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS.

RESULTS

Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; 4 (25%) pt had intra-His Wenckebach phenomenon, which correlated with Mobitz I (MI) atrioventricular block on the electrocardiogram. Seven (44%) pt had 2:1 atrioventricular block, 2 of whom were asymptomatic (12.5%). One (6%) pt had intra- and infra-His bundle block. Clinically, 11 (68%) pt had syncope or presyncope, 3 (18%) had dyspnea on exertion, and 2 (12.5%) were asymptomatic. Eight (50%) pt had bundle-branch block as follows: 4 (25%) pt had left bundle-branch block, and 4 (25%) had right bundle-branch block. Left anterosuperior divisional block was observed in 3 pt (19%), 2 of whom with associated right bundle-branch block.

CONCLUSION

Intra-His bundle block was observed in 11% of the pt with second-degree atrioventricular block, syncope or presyncope, or both, it being the most frequent clinical presentation. Intra-His bundle block was more common in the elderly (> 60 years) and among females. The most frequent electrocardiographic presentations were second-degree Mobitz I or type 2:1 atrioventricular block.

摘要

目的

评估接受电生理检查（EPS）的希氏束内阻滞患者的临床、心电图及电生理特征。

方法

我们分析了16例患有二度房室传导阻滞且有晕厥或呼吸困难症状，或两者皆有的患者在接受传统EPS检查时的特征。

结果

16例患者在EPS检查期间记录到希氏束内阻滞。15例（94%）患者的房室传导阻滞在窦性心律时被记录到；4例（25%）患者出现希氏束内文氏现象，这与心电图上的莫氏I型（MI）房室传导阻滞相关。7例（44%）患者出现2:1房室传导阻滞，其中2例无症状（12.5%）。1例（6%）患者同时存在希氏束内及希氏束下阻滞。临床上，11例（68%）患者有晕厥或先兆晕厥，3例（18%）患者运动时出现呼吸困难，2例（12.5%）无症状。8例（50%）患者有束支阻滞，具体如下：4例（25%）患者有左束支阻滞，4例（25%）有右束支阻滞。3例（19%）患者观察到左前分支阻滞，其中2例合并右束支阻滞。