Sobrino J A, del Rio A, Maté I, Pasalodos J, Sobrino N
Chest. 1978 Jan;73(1):109-13. doi: 10.1378/chest.73.1.109.
A patient with an acute inferior myocardial infarction developed a complete atrioventricular block and intermitent periods of atrioventricular conduction with QRS complexes showing right bundle branch block associated with left anterior hemiblock. Recordings of the His bundle electrogram showed that the atrioventricular block was infrahisian and that in periods of resumed atrioventricular conduction, the His-ventricle (H-V) interval was long. Ventricular escape beats showed concealed conduction to the atrioventricular node. Anterograde atrioventricular conduction was always resumed through the left posterior division when the preceding division when the preceding intervals between ventricular escape beats and the atrium (V-A intervals) were shorter than 580 msec. The same phenomenon occurred with right ventricular pacing. A retrograde His potential could be observed. Retrograde conduction of ventricular escape beats and ventricular paced beats was blocked if the H-V interval and the interval between the His bundle and the ventricular paced beat (H-V interval) were long (more than 600 msec and 550 msec, respectively). The existence of an intermittent anterograde and retrograde bradycardiac infrahisian block was inferred from the previously mentioned data; a fixed retrograde atrial nodal block was also present.
一名急性下壁心肌梗死患者发生了完全性房室传导阻滞，并伴有间歇性房室传导，其QRS波群显示右束支传导阻滞合并左前分支阻滞。希氏束电图记录显示房室传导阻滞位于希氏束以下，且在恢复房室传导期间，希氏束-心室（H-V）间期延长。室性逸搏心律对房室结有隐匿性传导。当室性逸搏心律与心房之间的前间期（V-A间期）短于580毫秒时，顺行性房室传导总是通过左后分支恢复。右心室起搏时也出现同样的现象。可观察到逆行性希氏束电位。如果H-V间期以及希氏束与心室起搏搏动之间的间期（H-V间期）延长（分别超过600毫秒和550毫秒），室性逸搏心律和心室起搏搏动的逆行传导会被阻滞。根据上述数据推断存在间歇性顺行性和逆行性希氏束以下的缓慢性传导阻滞；同时还存在固定性逆行性房室结阻滞。
