Leclercq J F, Maison-Blanche P, Cauchemez B, Letouzey J P, Coumel P, Slama R
Arch Mal Coeur Vaiss. 1985 Nov;78(12):1781-6.
Twelve patients with intrahisian AV block, confirmed later by electrophysiological investigations had Holter recordings showing the block (paroxysmal in 11 cases, permanent in 1 case). The diagnosis of the site of the block was made before endocavitary investigation in all cases on the following criteria: narrow QRS complexes in 10 out of 11 paroxysmal blocks (1 with phase III LBBB) with a sudden transition from 1/1 to 2/1 conduction. Only 3 patients had rare sequences of lower degree, Mobitz II block. Only 3 patients had 2 or more consecutive blocked P waves. The role of sinus tachycardia (block in phase III) was demonstrated in 10 out of 11 cases. The block was found on the first 24 hour Holter recording in all but 1 patient. This contrasts with paroxysmal trifascicular block: out of 46 patients recruited during the same period, only 4 had Holter recordings showing the block and this was not reproducible. The 12th patient had permanent AV block with wide QRS complexes and narrow sinus captures in the supernormal period in the morning. The sudden transition from 1/1 to 2/1 conduction in phase III is characteristic of intrahisian block and distinguishes it from intranodal AV block. All patients were improved by VDD mode pacing.
12例希氏束内房室传导阻滞患者，后来经电生理检查得以确诊，其动态心电图记录显示有传导阻滞（11例为阵发性，1例为永久性）。所有病例均在腔内检查前根据以下标准做出阻滞部位的诊断：11例阵发性传导阻滞中有10例QRS波群狭窄（1例伴有Ⅲ相性左束支传导阻滞），传导突然从1:1转变为2:1。只有3例患者出现过罕见的低程度莫氏Ⅱ型传导阻滞序列。只有3例患者有2次或更多次连续的P波阻滞。11例中有10例证实了窦性心动过速（Ⅲ相阻滞）的作用。除1例患者外，所有患者均在首次24小时动态心电图记录中发现了传导阻滞。这与阵发性三分支传导阻滞形成对比：在同一时期招募的46例患者中，只有4例动态心电图记录显示有传导阻滞，且不可重复。第12例患者有永久性房室传导阻滞，QRS波群增宽，早晨超常期有窄的窦性夺获。Ⅲ相中从1:1到2:1传导的突然转变是希氏束内阻滞的特征，可将其与结内房室传导阻滞区分开来。所有患者采用VDD模式起搏后病情均有改善。
