Sugenoya J
Jpn Heart J. 1978 Jan;19(1):12-27. doi: 10.1536/ihj.19.12.
Body surface isopotential maps were produced by computer processing of the 85 electrocardiograms obtained from the entire thorax of 28 patients with complete or incomplete right bundle branch block (RBBB). We divided the map patterns into the following 3 groups. Type I map pattern (10 cases): at the early stage of QRS, the maximum was located in the left chest. It shifted to the left from the normal position; at the instant of 44 msec, on the average, after the onset of QRS breakthrough minimum appeared over the left chest. Its appearance was delayed and its site shifted to the left as compared with the normal; at the late stage, the positive zone covered extensively the right chest and the right back; terminally, the maximum was positioned along the right parasternum. Type II map pattern (13 cases): at the early stage of QRS, the maximum was in the left chest as in Type I; breakthrough minimum appeared at 38 msec on the average, later than in the normal, but the site of breakthrough minimum varied from the left chest as in Type I to the midsternal region as in the normal; at the late stage, the positive zone covered the upper part of the right chest and the right back, less extensively than in Type I; the terminal maximum was in the upper sternal region. Type III map pattern (5 cases): the map pattern passed normally until the late stage, but thereafter a small positive zone survived over the upper sternal region. In Type I the delayed activation was presumed to occur all over the right ventricle, in Type II mainly over the smaller area of the right anterior free wall, and in Type III over the localized area of the outflow tract. Patients with complete RBBB showed Type I pattern. Patients with incomplete RBBB showed Type II or Type III pattern, although electrocardiograms failed to differentiate Type II patients from Type III patients. These findings suggest that the electrocardiographic pattern of incomplete RBBB probably arises from the various mechanisms.
通过对28例完全性或不完全性右束支传导阻滞（RBBB）患者整个胸部记录的85份心电图进行计算机处理，生成体表等电位图。我们将图谱模式分为以下3组。I型图谱模式（10例）：在QRS波早期，最大值位于左胸，较正常位置向左移位；平均在QRS波起始后44毫秒时，左胸出现突破最小值。与正常情况相比，其出现延迟且位置向左移位；在晚期，正区广泛覆盖右胸和右背部；终末时，最大值位于右胸骨旁。II型图谱模式（13例）：在QRS波早期，最大值与I型一样位于左胸；突破最小值平均出现在38毫秒，比正常情况晚，但突破最小值的位置从I型的左胸变化到正常情况的胸骨中部区域；在晚期，正区覆盖右胸上部和右背部，范围比I型小；终末最大值位于胸骨上部区域。III型图谱模式（5例）：图谱模式直到晚期都正常，但此后在胸骨上部区域仍存在一个小的正区。在I型中，推测延迟激动发生在整个右心室，在II型中主要发生在右前游离壁较小区域，在III型中发生在流出道局部区域。完全性RBBB患者表现为I型模式。不完全性RBBB患者表现为II型或III型模式，尽管心电图无法区分II型患者和III型患者。这些发现提示，不完全性RBBB的心电图模式可能由多种机制引起。
