St. Antonius-Hospital Gronau GmbH, Cardiology, Germany.
Int J Cardiol. 2012 May 17;157(1):102-3. doi: 10.1016/j.ijcard.2011.09.070. Epub 2011 Oct 28.
We searched for special features in patients with complete and incomplete right bundle branch block diagnosed as having arrhythmogenic right ventricular cardiomyopathy/dysplasia. Whether right bundle branch block is a frequent finding in arrhythmogenic right ventricular cardiomyopathy should be studied. The question is whether special features exist such as T-wave inversions, localized right precordial QRS prolongation and r'/s ratio<1.
ARVC could be diagnosed according to ISFC/ESC criteria in 374 patients. CRBBB was found in 22 cases (6%) and iCRBBB was present in 47 cases (12.5%). In CRBBB T wave inversions ≥ V4 was found in 10 cases (n.s.) and r'/s ratio<1 was present in 12 cases (p<0.001). In iCRBBB T wave inversions ≥ V4 was found in 10 cases (n.s.) and ST segment elevation in right precordial leads was present in 19 cases (p<0.005). In all patients with ARVC localized right precordial QRS prolongation was found. Patients with CRBBB have a bad prognosis: 17 of 22 patients developed biventricular heart failure requiring heart transplantation and diuretic therapy.
CRBBB and iCRBBB are infrequent findings in arrhythmogenic right ventricular cardiomyopathy. Complete right bundle branch block is characterized by r'/s ratio<1. There are no significant T wave inversions ≥ V4. Incomplete right bundle branch block is characterized by ST segment elevation in right precordial leads but not by T wave inversions ≥ V4.
我们在被诊断为致心律失常性右室心肌病/发育不良的完全性和不完全性右束支传导阻滞患者中寻找特殊特征。右束支传导阻滞是否为致心律失常性右室心肌病的常见表现尚需研究。问题是是否存在特殊特征，如 T 波倒置、局部右胸前导联 QRS 延长和 r'/s 比值<1。
根据 ISFC/ESC 标准，可在 374 例患者中诊断 ARVC。CRBBB 见于 22 例（6%），iCRBBB 见于 47 例（12.5%）。在 CRBBB 中，T 波倒置≥V4 见于 10 例（无统计学意义），r'/s 比值<1 见于 12 例（p<0.001）。在 iCRBBB 中，T 波倒置≥V4 见于 10 例（无统计学意义），右胸前导联 ST 段抬高见于 19 例（p<0.005）。所有 ARVC 患者均存在局部右胸前导联 QRS 延长。CRBBB 患者预后不良：22 例患者中有 17 例发展为双心室心力衰竭，需要心脏移植和利尿剂治疗。
CRBBB 和 iCRBBB 在致心律失常性右室心肌病中少见。完全性右束支传导阻滞的特征是 r'/s 比值<1。不存在明显的 T 波倒置≥V4。不完全性右束支传导阻滞的特征是右胸前导联 ST 段抬高，但无 T 波倒置≥V4。
