不完全性左束支传导阻滞合并双分支阻滞模式的临床意义。

Clinical significance of the pattern of incomplete left bundle branch block with bifascicular block.

作者信息

Piotrowicz R, Dabrowski A

出版信息

Cor Vasa. 1985;27(1):47-53.

Abstract

A comparative analysis was carried out of 126 patients (group I) with chronic right bundle branch block (RBBB) and left anterior (LAFB) or left posterior fascicle block (LPFB), and of 44 patients (group II) with the same bifascicular block associated with an ECG pattern of incomplete left bundle branch block (ILBBB). The two groups were found to be clinically different. In group II, heart failure, arrhythmia and first-degree atrioventricular block occurred significantly more frequently. During a mean follow-up period of 1581 +/- 118 days (85-6260 days), complete heart block (CHB) developed in 3.2% of patients in group I and in 22.7% in group II (p less than 0.01). In the same period, sudden cardiac death (SCD) occurred in 3.9% in group I and in 15.9 in group II (p less than 0.01). These results were analysed assuming a quadrifascicular character of the intraventricular conduction system. This made it possible to isolate on the basis of standard ECG findings patients with trifascicular block (group II--RBBB and LAFB or LPFB and septal LBBB) in whom prophylactic pacemaker implantation should be considered in view of high risk of CHB and SCD.

摘要

对126例慢性右束支传导阻滞（RBBB）合并左前分支阻滞（LAFB）或左后分支阻滞（LPFB）的患者（I组）以及44例具有相同双分支阻滞且伴有不完全性左束支传导阻滞（ILBBB）心电图模式的患者（II组）进行了对比分析。结果发现两组在临床上存在差异。在II组中，心力衰竭、心律失常和一度房室传导阻滞的发生率明显更高。在平均随访期1581±118天（85 - 6260天）内，I组3.2%的患者发生了完全性心脏传导阻滞（CHB），II组为22.7%（p<0.01）。同期，I组3.9%的患者发生心源性猝死（SCD），II组为15.9%（p<0.01）。基于心室传导系统的四分支特征对这些结果进行了分析。这使得根据标准心电图结果能够识别出三分支阻滞患者（II组 - RBBB和LAFB或LPFB以及间隔性LBBB），鉴于其发生CHB和SCD的高风险，应考虑预防性植入起搏器。