Cohen H C, D'Cruz I, Pick A
Circulation. 1976 May;53(5):776-83. doi: 10.1161/01.cir.53.5.776.
Multiple areas of concealed intraventricular conduction are deduced on the basis of aftereffects observed in His bundle recordings. Electrocardiograms and His bundle recordings are presented from two patients with unstable bilateral bundle branch block, the instability of which depended on the interval at which ventricular depolarization was initiated by sinus or paced impulses. This circumstance allows postulation of 1) concealed transseptal retrograde penetration of the left bundle branch system; 2) concealed transseptal retrograde penetration of the right bundle branch system; 3) alternate beat Wenckebach phenomenon with two areas of block in the bundle branch system with concealed penetration of the proximal area; 4) concealed re-entry in the right bundle branch system during an H-V Wenckebach cycle with resetting of the sequence of 2:1 H-V block and return of the re-entry wave to the A-V node causing subsequent A-H block; 5) proximal 2:1 block and distal Wenckebach block producing only two consecutively blocked beats; and 6) infrahisian Wenckebach block with changes both in A-V conduction and QRS contour.
根据希氏束记录中观察到的后遗症推断出多个隐匿性室内传导区域。本文展示了两名不稳定双侧束支传导阻滞患者的心电图和希氏束记录，其不稳定性取决于窦性或起搏冲动引发心室去极化的间期。这种情况使得可以假设：1）左束支系统的隐匿性经间隔逆行穿透；2）右束支系统的隐匿性经间隔逆行穿透；3）束支系统中两个阻滞区域交替搏动的文氏现象，近端区域存在隐匿性穿透；4）在H-V文氏周期中右束支系统的隐匿性折返，伴有2:1 H-V阻滞序列的重置，折返波返回房室结导致随后的A-H阻滞；5）近端2:1阻滞和远端文氏阻滞仅产生两个连续的阻滞搏动；6）希氏束下文氏阻滞，伴有房室传导和QRS波形态的改变。
