Kaneko Yoshiaki, Nakajima Tadashi, Saito Akihiro, Irie Tadanobu, Ota Masaki, Kato Toshimitsu, Iijima Takafumi, Manita Mamoru, Ito Toshio, Akiyama Masahiro, Taniguchi Yasuhiro, Kurabayashi Masahiko
Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S72-5. doi: 10.1111/j.1540-8159.2008.02231.x.
The purpose of this study was to identify the His-bundle (HB) versus right bundle branch (RBB) during electrophysiologic studies, using the V3 phenomenon, and to compare the timing of HB versus RBB potentials of sinus cycles (His-ventricular [H-V] interval).
The study enrolled 16 patients without structural heart disease, who underwent electrophysiologic studies during which the H-V interval was within normal limits and the V3 phenomenon was induced during recordings of the HB and the RBB potentials by a multi-electrode catheter. The recording site of the earliest HB potential just before the V3 phenomenon was defined as the branching portion of His bundle (HBBP), the site immediately proximal to the HBBP as the HB, and the site immediately distal to the HBBP as the RBB.
The HBBP was identified in all patients. In all cases but one patient, the H-V interval measured at the HB adjacent to the HBBP was > or =35 ms. However, in 12 patients, the H-V interval measured at the RBB adjacent to the HBBP was also > or =35 ms.
The electrophysiologic identification of HB versus RBB by simultaneous recordings of HB and RBB potentials during induction of the V3 phenomenon was feasible. When the discrimination between HB and RBB was based on the measurement of the H-V interval, the proximal portion of the RBB was frequently misidentified as the HB.
本研究的目的是在电生理研究中利用V3现象鉴别希氏束（HB）与右束支（RBB），并比较窦性心律周期中希氏束与右束支电位的时间（希氏束-心室[H-V]间期）。
本研究纳入16例无结构性心脏病的患者，这些患者接受了电生理研究，期间H-V间期在正常范围内，并且在通过多电极导管记录希氏束和右束支电位时诱发了V3现象。将V3现象出现前最早的希氏束电位记录部位定义为希氏束分支部分（HBBP），紧邻HBBP近端的部位为希氏束，紧邻HBBP远端的部位为右束支。
所有患者均识别出了HBBP。除1例患者外，在所有病例中，紧邻HBBP的希氏束处测得的H-V间期≥35 ms。然而，在12例患者中，紧邻HBBP的右束支处测得的H-V间期也≥35 ms。
在诱发V3现象期间同时记录希氏束和右束支电位来进行希氏束与右束支的电生理鉴别是可行的。当基于H-V间期的测量来区分希氏束和右束支时，右束支的近端部分常被误识别为希氏束。
