Di Biase M, Tritto M, Sabato G, Pitzalis M V, Rizzon P
Division of Cardiology, University of Bari, Italy.
Eur Heart J. 1991 Mar;12(3):368-77. doi: 10.1093/oxfordjournals.eurheartj.a059904.
The electrocardiographic patterns, observed during 24-h Holter monitoring, of 10 patients (mean age 35 +/- 22 years) with first and second degree A-V block due to dual A-V nodal pathways are reported. Recordings were selected according to the presence of: sudden and persistent prolongation of the PR interval: sudden normalization of the PR interval: 'atypical' Wenckebach sequences showing sudden and pronounced prolongation of any PR interval prior to the blocked P wave. Besides the already recognized pattern, new aspects were identified: (1) Wenckebach sequences in the slow and fast pathways characterized by a progressive increase in the PR interval until a blocked P wave occurred during long and short PR interval periods, respectively; (2) Wenckebach periods first in the slow and then in the fast pathway; (3) 2:1 A-V block with a normal PR interval in the conducted beat after a Wenckebach sequence in the slow pathway; (4) Wenckebach in the fast pathway and, subsequently, in the slow one characterized by a slight prolongation of the PR interval for some beats followed by a sudden and pronounced increase in the PR interval of one beat and a subsequent progressive slight PR prolongation until a blocked P wave occurred; (5) Wenckebach sequence in the fast pathway with subsequent conduction over the slow pathway without a blocked P wave; (6) blocked P waves during both long and short PR interval periods with slight prolongation of the preceding PR interval. The electrophysiological mechanisms involved in these electrocardiographic patterns together with the nature (anatomical or functional) of the intranodal pathways and the clinical significance of this type of block are discussed.
报告了10例（平均年龄35±22岁）因双房室结径路导致一度和二度房室传导阻滞患者在24小时动态心电图监测期间观察到的心电图模式。根据以下情况选择记录：PR间期突然持续延长；PR间期突然恢复正常；“非典型”文氏序列，表现为阻滞P波前任何PR间期突然显著延长。除了已识别的模式外，还发现了新的方面：（1）慢径路和快径路中的文氏序列，其特征是PR间期逐渐增加，直到分别在长PR间期和短PR间期期间出现阻滞P波；（2）先在慢径路后在快径路出现文氏周期；（3）慢径路出现文氏序列后，下传搏动的PR间期正常的2:1房室传导阻滞；（4）快径路出现文氏现象，随后慢径路出现文氏现象，特征是部分搏动的PR间期轻度延长，随后一个搏动的PR间期突然显著增加，随后PR间期逐渐轻度延长，直到出现阻滞P波；（5）快径路出现文氏序列，随后经慢径路传导且无阻滞P波；（6）长PR间期和短PR间期期间均出现阻滞P波，前一个PR间期轻度延长。讨论了这些心电图模式所涉及的电生理机制，以及结内径路的性质（解剖学或功能性）和这种类型传导阻滞的临床意义。
