Préda I, Bukosza I, Kozmann G, Shakin V V, Székely A, Antalóczy Z
Jpn Heart J. 1979 Jan;20(1):7-21. doi: 10.1536/ihj.20.7.
The sequences of myocardial excitation in the cases of human LBBB have been studied by the surface mapping technique. Analysis of the surface map patterns of 12 subjects has enabled 4 different types to be described. It is suggested that Type I represents a complete LBBB in the presence of an intact right bundle branch, while Types II and III show different degrees of conduction defect in the right bundle branch, too. The left ventricular activation of these 3 types has a similar pathway in phases II and III which is determined by orientation of the main subepicardial muscle layer coursing through the apex and terminating in the anterobasal region. The terminal anterobasal activation in the cases of LBBB has not only theoretical, but clinical significance, since in the presence of anteroseptal myocardial infarction the signs of necrosis must be hidden not in the early, but in the terminal parts of the QRS complex of conventional ECG. The lack of terminal anterior positivity of surface maps in the case of LBBB may be indicative of chronic anterior myocardial infarction.
通过体表标测技术研究了人类左束支传导阻滞（LBBB）病例中心肌兴奋的序列。对12名受试者的体表标测图模式分析，已能描述出4种不同类型。有人提出，I型代表右束支完整情况下的完全性LBBB，而II型和III型也显示右束支不同程度的传导缺陷。这3种类型的左心室激动在II期和III期有相似的途径，该途径由穿过心尖并终止于前基底部的主要心外膜下肌层的走行方向决定。LBBB病例中终末前基底部激动不仅具有理论意义，而且具有临床意义，因为在前间隔心肌梗死存在时，坏死征象必定不是隐藏在常规心电图QRS波群的早期部分，而是隐藏在终末部分。LBBB病例中体表标测图缺乏终末前正向性可能提示慢性前壁心肌梗死。
