Jastrzebski Marek, Kukla Piotr
1st Department of Cardiology and Hypertension, University Hospital, ul. Kopernika 17, Krakow, Poland.
J Electrocardiol. 2009 Nov-Dec;42(6):684-6. doi: 10.1016/j.jelectrocard.2009.06.001. Epub 2009 Jun 30.
We present the case of a 72-year-old man who was admitted because of acute ST-segment elevation myocardial infarction and presented with second-degree atrioventricular block with 4:2 conduction. We propose 3 alternative explanations for such an unusual conduction pattern: (1) supernormal conduction, (2) 2-level block with 4:1 conduction ratio in the upper level and 3:2 conduction ratio in the lower level, and (3) presence of 2 populations of Purkinje cells in the remaining, critically injured fascicle, one with the phase-3 block and the other with slow diastolic depolarization, leading, during a pause after the first nonconducted P, to phase-4 block.
我们报告了一例72岁男性患者，因急性ST段抬高型心肌梗死入院，伴有二度房室传导阻滞，传导比例为4:2。对于这种不寻常的传导模式，我们提出了3种可能的解释：（1）超常传导；（2）二级阻滞，上级传导比例为4:1，下级传导比例为3:2；（3）在剩余严重受损的束支中存在2组浦肯野细胞，一组具有3相阻滞，另一组具有缓慢舒张期去极化，在第一个未下传的P波后的间歇期导致4相阻滞。
