Rakovec P, Kranjec I, Fettich J J, Jakopin J, Fidler V, Turk J
Clin Cardiol. 1985 Jan;8(1):51-6. doi: 10.1002/clc.4960080108.
Coinciding left bundle-branch block and Wolff-Parkinson-White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cardiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right-sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle-branch block was seen. Left bundle-branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combined electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates.
在一名扩张型心肌病患者中发现了罕见的心电图表现，即同时存在左束支传导阻滞和B型预激综合征。电生理研究显示，心室起搏时心房逆向激动呈偏心性，提示右侧旁路。程控心房起搏时，旁路的有效不应期为310毫秒；起搏耦联间期较短时，可见伴有左束支传导阻滞的正常房室传导。希氏束起搏时也可见左束支传导阻滞。放射性核素相位成像显示右心室相位提前和左心室相位延迟；左右心室相位图像均显示宽相位分布直方图。联合电生理和放射性核素检查有助于揭示复杂的传导异常及其机械关联。
