Wilner C, Garnier-Crussard J P, Huygue De Mahenge A, Gayet C, André-Fouet X, Pont M
Presse Med. 1983 Dec 24;12(47):2987-9.
Two cases of pulmonary embolism accompanied by syncope in patients with pre-existing left bundle branch block are reported. Contrary to classical descriptions, the syncopes in these two patients could not be ascribed to cardiovascular collapse, but several arguments (such as the clinical features of the syncope and its coexistence in one case with ECG evidence of complete atrio-ventricular dissociation) were in favour of a paroxysmal disorder of conduction. Right bundle branch block is known to be common in pulmonary embolism and may even be more frequent in patients with left bundle branch block. In such cases, sudden and transient arrest of conduction in the right bundle would complete the left bundle branch block, thus accounting for a paroxysmal atrio-ventricular block.
报告了两例既往有左束支传导阻滞的患者发生肺栓塞并伴有晕厥的病例。与经典描述相反，这两名患者的晕厥并非归因于心血管虚脱，而是有几个论据（如晕厥的临床特征以及其中一例伴有完全性房室分离的心电图证据）支持传导阵发性障碍。右束支传导阻滞在肺栓塞中很常见，在有左束支传导阻滞的患者中甚至可能更频繁。在这种情况下，右束支传导的突然和短暂阻滞会使左束支传导阻滞完全形成，从而导致阵发性房室传导阻滞。
