Kistler Peter M, Mond Harry G, Vohra Jitendra K
Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia.
Pacing Clin Electrophysiol. 2003 Oct;26(10):1997-9. doi: 10.1046/j.1460-9592.2003.00308.x.
Pacemaker ventricular block is a rare and poorly recognized electrocardiographic abnormality usually identified in terminally ill pacemaker patients. Because the patient is frequently moribund and the phenomenon transient, it is probably overlooked and not well documented. It is characterized by an altered temporal relationship between the pacemaker stimulus artifact and the subsequent paced QRS. The most common presentation is a delay or latency between the stimulus artifact and the QRS called first-degree pacemaker ventricular block. This can then deteriorate to periodic episodes of failure to capture the myocardium referred to as second-degree pacemaker ventricular block that may manifest as a classical Wenckebach or higher levels of block. Any further deterioration results in a third-degree pacemaker ventricular block, which is failure to capture the ventricle and asystole. This article describes electrocardiographic examples of this phenomenon.
起搏器心室传导阻滞是一种罕见且认识不足的心电图异常，通常在晚期起搏器患者中发现。由于患者常常处于濒死状态且该现象短暂，可能被忽视且记录不充分。其特征是起搏器刺激伪迹与随后的起搏QRS波之间的时间关系改变。最常见的表现是刺激伪迹与QRS波之间的延迟或潜伏期，称为一度起搏器心室传导阻滞。然后可能会恶化为间歇性不能夺获心肌，称为二度起搏器心室传导阻滞，可表现为典型的文氏现象或更高程度的阻滞。进一步恶化则导致三度起搏器心室传导阻滞，即不能夺获心室和心脏停搏。本文描述了该现象的心电图实例。
