Baerman J M, Bauernfeind R A, Swiryn S
Department of Medicine, Northwestern University Medical School, Evanston, Illinois.
J Am Coll Cardiol. 1989 Jan;13(1):215-9. doi: 10.1016/0735-1097(89)90573-1.
Previous studies of the effects of bundle branch block on ventriculoatrial (VA) intervals during orthodromic reciprocating tachycardia have focused on the timing of the atrial electrograms. However, left bundle branch block importantly affects the timing of initial ventricular activation, and this effect would also be expected to affect VA intervals during orthodromic reciprocating tachycardia. Presented here are three patients with a single right-sided accessory atrioventricular pathway exhibiting left bundle branch block during orthodromic reciprocating tachycardia. Each had shortening of the VA interval by 10 to 30 ms during left bundle branch block beats. This shortening was accompanied by a nearly equal increase in the HV interval, with the His bundle to atrial interval remaining constant. It is concluded that the timing of ventricular as well as atrial electrograms impacts on the VA intervals with left bundle branch block beats during orthodromic reciprocating tachycardia. With left bundle branch block, delay in initial left septal activation results in later onset of the QRS complex and, with right ventricular activation occurring normally, shortening of the VA interval occurs in patients with a right-sided pathway.
以往关于束支传导阻滞对顺向型折返性心动过速时室房（VA）间期影响的研究主要集中在心房电图的时间上。然而，左束支传导阻滞会显著影响心室初始激动的时间，预计这种影响也会在顺向型折返性心动过速时影响VA间期。本文介绍了3例在顺向型折返性心动过速时表现为左束支传导阻滞的右侧单旁道房室旁路患者。在左束支传导阻滞搏动时，每例患者的VA间期均缩短10至30毫秒。这种缩短伴随着HV间期几乎相等的增加，希氏束至心房间期保持不变。结论是，在顺向型折返性心动过速时，左束支传导阻滞搏动时心室和心房电图的时间均会影响VA间期。存在左束支传导阻滞时，左间隔初始激动延迟导致QRS波群起始延迟，且右心室激动正常发生，右侧旁路患者的VA间期会缩短。
