Doi Y, Ogawa S, Hiroki T, Arakawa K
Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Japan.
Jpn Heart J. 1990 Nov;31(6):767-76. doi: 10.1536/ihj.31.767.
One hundred and fifty-seven patients with complete right bundle branch block (CRBBB) were studied with echocardiography (UCG). In 87 of them, both ECG and UCG of good quality were obtained and analyzed to differentiate the site of the block within the right bundle. Their mean age was 53.2 +/- 17.6 (SD) years, and they consisted of 62 males (50.2 +/- 16.8 years) and 25 females (60.8 +/- 17.3 years), suggesting that males were more susceptible to CRBBB than females, with a male to female ratio of 2.48 among our study group. In a normal control group, the time interval from the initial deflection of the QRS complex of the ECG to mitral valve closure (QMC) was 52.3 +/- 11.6 msec, to tricuspid valve closure (QTC) 87.7 +/- 11.5 msec, to the point of full opening of the pulmonary valve (QPO) 124.5 +/- 13.7 msec, from mitral to tricuspid valve closure (MCTC) 35.5 +/- 11.2 msec, and from tricuspid valve closure to the maximum opening of the pulmonary valve (TCPO) 38.0 +/- 13.8 msec, and in patients with CRBBB, QMC 58.7 +/- 13.2 msec, QTC 95.4 +/- 24.2 msec, QPO 169.1 +/- 24.6 msec, MCTC 36.7 +/- 18.2 msec, and TCPO 73.7 +/- 23.7 msec. Although prolonged QMC and QTC are characteristic features in CRBBB as a whole, CRBBB was divided into 4 groups in this study depending on the difference in MCTC and TCPO: Proximal block with prolonged MCTC, peripheral block with prolonged TCPO, diffuse block with both MCTC and TCPO prolonged, and non-specific block without prolongation of either of the two. The incidences were 11.5% (10 patients) for proximal block, 64.4% (56 patients) for peripheral block, 16.1% (14 patients) for diffuse block, and 8.0% (7 patients) for non-specific block. Thus, conduction disturbance in the peripheral portion of the right bundle branch was observed in 80.5% of our cases, suggesting that peripheral block is much more common than proximal block in adults.
对157例完全性右束支传导阻滞（CRBBB）患者进行了超声心动图（UCG）检查。其中87例患者获得了质量良好的心电图（ECG）和UCG，并进行分析以区分右束支内阻滞的部位。他们的平均年龄为53.2±17.6（标准差）岁，包括62名男性（50.2±16.8岁）和25名女性（60.8±17.3岁），这表明男性比女性更容易发生CRBBB，在我们的研究组中男女比例为2.48。在正常对照组中，心电图QRS波群初始偏转至二尖瓣关闭（QMC）的时间间隔为52.3±11.6毫秒，至三尖瓣关闭（QTC）为87.7±11.5毫秒，至肺动脉瓣完全开放点（QPO）为124.5±13.7毫秒，二尖瓣至三尖瓣关闭（MCTC）为35.5±11.2毫秒，三尖瓣关闭至肺动脉瓣最大开放（TCPO）为38.0±13.8毫秒；在CRBBB患者中，QMC为58.7±13.2毫秒，QTC为95.4±24.2毫秒，QPO为169.1±24.6毫秒，MCTC为36.7±18.2毫秒，TCPO为73.7±23.7毫秒。虽然QMC和QTC延长是CRBBB总体的特征性表现，但在本研究中，根据MCTC和TCPO的差异将CRBBB分为4组：MCTC延长的近端阻滞、TCPO延长的外周阻滞、MCTC和TCPO均延长的弥漫性阻滞以及两者均未延长的非特异性阻滞。其发生率分别为近端阻滞11.5%（10例）、外周阻滞64.4%（56例）、弥漫性阻滞16.1%（14例）、非特异性阻滞8.0%（7例）。因此，在我们的病例中，80.5%观察到右束支外周部分的传导障碍，这表明在成年人中外周阻滞比近端阻滞更为常见。
