Peters R W, Scheinman M M, Raskin S, Desai J
Circulation. 1979 Oct;60(4):956-9. doi: 10.1161/01.cir.60.4.956.
Consistent His bundle pacing was accomplished in one of 60 consecutive patients. Intracardiac electrophysiologic studies in this patient revealed rapid atrioventricular nodal conduction (AH = 55 msec). While the relative refractory period of the His-Purkinje system as a whole determined by His bundle pacing (using the extrastimulus technique) was identical to that determined by atrial pacing, changes in right bundle branch refractoriness differed. An atrial extrasystolic interval of 370 msec resulted in right bundle branch block, whereas direct His pacing at a shorter extrasystolic interval (360 msec) failed to produce a bundle branch block pattern. The effective refractory period of the His-Purkinje system could not be determined by atrial pacing because of atrial refractoriness, but was obtained by His bundle pacing. Theoretically, direct His bundle pacing may be of value in determining His-Purkinje system refractoriness when this parameter is unobtainable due to either atrial or atrioventricular nodal refractoriness. This technique appears to have limited clinical usefulness, however, because of the very small success rates. Finally, His-Purkinje system refractoriness may differ, depending on site of stimulation, presumably due to differing inputs into the His-Purkinje system.
在连续60例患者中，有1例成功实现了希氏束起搏。对该患者进行的心内电生理研究显示房室结传导迅速（AH = 55毫秒）。虽然通过希氏束起搏（采用期外刺激技术）确定的整个希氏-浦肯野系统的相对不应期与心房起搏确定的相同，但右束支不应期的变化有所不同。370毫秒的房性期前收缩间期导致右束支传导阻滞，而在更短的期前收缩间期（360毫秒）直接进行希氏束起搏未能产生束支传导阻滞图形。由于心房不应期，无法通过心房起搏确定希氏-浦肯野系统的有效不应期，但可通过希氏束起搏获得。理论上，当由于心房或房室结不应期而无法获得该参数时，直接希氏束起搏在确定希氏-浦肯野系统不应期方面可能具有价值。然而，由于成功率非常低，该技术的临床实用性似乎有限。最后，希氏-浦肯野系统的不应期可能因刺激部位而异，推测是由于对希氏-浦肯野系统的输入不同。
