Barbosa E C, Ginefra P, da Rocha P J, Musse N S, Boghossian S H, Albanesi Filho F M, Gomes Filho J B
Hospital Universitário Pedro Ernesto--UERJ.
Arq Bras Cardiol. 1991 May;56(5):355-8.
Evaluation of the prolonged PR interval and its predictive value for trifascicular block in individuals with bifascicular His bundle branch block.
55 patients, 36 male and 19 female aged 57 + 15.8 years with bifascicular bundle branch block type have been studied. 11 cases had complete left bundle branch block and 44 cases had complete right bundle branch block with left anterior and superior division block. His bundle electrogram and atrial stimulation were performed in all patients. The atrial stimulation rate originating the Wenckebach phenomenon (SP) of the A-V conduction, and the A-H and H-V intervals were compared with the PR interval of the surface electrocardiogram. Patients were divided into three groups according to the PR interval: group I, Pr less than 200 ms, group II, PR between 190-280 ms and group III, PR greater than or equal to 280 ms.
There was not linear correlation between the PR interval and WP in the three groups. There was a weak linear ascending correlation between the PR and A-H intervals in groups I and II (r + 0.59 and + + 0.43, respectively) and there was a descending correlation in the group III (r. - 0.64, P less than 0.05). In relation to the H-V interval there was not linear correlation with the PR interval in groups I and II, but there was a good ascending linear correlation in the group III (r 0.84, P less than 0.01). The incidence of prolonged A-H and H-V intervals increased as the PR interval was larger.
The prolonged PR interval with bifascicular bundle branch block means, in the majority of cases, diffuse damage of the conduction system involving the A-V node and the infranodal region; starting from 280 ms, the delayed PR interval suggests involvement predominantly below the A-V node: to a higher PR interval corresponds a higher H-V interval and also, to a relatively shortest A-H interval.
评估双分支希氏束传导阻滞患者中PR间期延长及其对三分支传导阻滞的预测价值。
研究了55例患者，年龄57±15.8岁，其中男性36例，女性19例，均为双分支传导阻滞类型。11例为完全性左束支传导阻滞，44例为完全性右束支传导阻滞合并左前分支和左后分支传导阻滞。对所有患者进行了希氏束电图和心房刺激检查。将引发房室传导文氏现象（SP）的心房刺激率以及A-H和H-V间期与体表心电图的PR间期进行比较。根据PR间期将患者分为三组：I组，PR小于200毫秒；II组，PR在190 - 280毫秒之间；III组，PR大于或等于280毫秒。
三组中PR间期与文氏现象之间无线性相关性。I组和II组中PR与A-H间期之间存在弱的线性上升相关性（分别为r = +0.59和r = +0.43），而III组中存在下降相关性（r = -0.64，P < 0.05）。关于H-V间期，I组和II组中与PR间期无线性相关性，但III组中存在良好的上升线性相关性（r = 0.84，P < 0.01）。随着PR间期增大，A-H和H-V间期延长的发生率增加。
双分支传导阻滞时PR间期延长在大多数情况下意味着传导系统的弥漫性损伤，累及房室结和结下区域；从280毫秒起，延迟的心电PR间期提示主要累及房室结以下；PR间期越高，H-V间期越高，且A-H间期相对最短。
