Tajima T, Nakamura Y, Murata K
Jpn Circ J. 1979 May;43(5):403-20. doi: 10.1253/jcj.43.403.
In order to investigate the pathophysiology of tachycardia and bradycardia dependent block in the His-Purkinje system, anterior septal artery was ligated and the effects of vagal stimulation and atrial pacing were serially checked in 26 dogs. Tachycardia dependent intra-His bundle block or H-V blocks developed in all cases following ligation of the anterior septal artery and bradycardia dependent block ensued in 3 cases. The latter appeared only in the form of split His bundle or lengthening of the H-V intervals. Spontaneous second or third degree AV block appeared thereafter. Bundle branch block appeared in 19 cases after ligation of the artery. Rate dependent bundle branch block was observed before the development of stable bundle branch block. Frequently, a very long pause was necessary to produce bradycardia dependent block. On the other hand, bradycardia dependent H-V blocks by vagal stimulation were not necessarily dependent upon cardiac cycle length alone. Tachycardia dependent paroxysmal A-V blocks were induced in 7 cases by atrial pacing, soon before or after the onset of spontaneous second degree A-V block. In addition, this block was induced in the very early phase after ligation of the artery in one case. This repetitive intra-His bundle block or H-V block was induced not only by progressive increase in pacing rate but also by gradual decrease in pacing rate after a Wenckebach type of second degree A-H block.
为了研究希氏 - 浦肯野系统中与心动过速和心动过缓相关的阻滞的病理生理学，对26只犬结扎前间隔动脉，并连续检查迷走神经刺激和心房起搏的影响。结扎前间隔动脉后，所有病例均出现与心动过速相关的希氏束内阻滞或H-V阻滞，3例出现与心动过缓相关的阻滞。后者仅表现为希氏束分裂或H-V间期延长的形式。此后出现自发性二度或三度房室阻滞。结扎动脉后19例出现束支阻滞。在稳定的束支阻滞形成之前观察到频率依赖性束支阻滞。通常，需要很长的间歇才能产生与心动过缓相关的阻滞。另一方面，迷走神经刺激引起的与心动过缓相关的H-V阻滞不一定仅取决于心动周期长度。在7例中，在自发性二度房室阻滞发作之前或之后不久，通过心房起搏诱发了与心动过速相关的阵发性房室阻滞。此外，在1例中，在结扎动脉后的早期阶段诱发了这种阻滞。这种重复性的希氏束内阻滞或H-V阻滞不仅由起搏频率的逐渐增加引起，也由文氏型二度A-H阻滞之后起搏频率的逐渐降低引起。
