Akhtar M, Gilbert C, Wolf F G, Schmidt D H
Circulation. 1978 Aug;58(2):295-304. doi: 10.1161/01.cir.58.2.295.
Routes of impulse propagation during reentry in the His-Purkinje system (Re-HPS) in 13 patients were studied using the right ventricular extra stimulus (V2) method and right bundle branch (RBB) recordings in addition to the conventional His (H) bundle recordings. The H-V and RB-V intervals during sinus rhythm averaged 44.2 and 27.6 msec respectively, with the average antegrade H-RB interval 16.6 msec. All 13 patients demonstrated Re-HPS in the form of V3 showing a left bundle branch block (LBBB) pattern, and two of the 13 patients also manifested V3 with a right bundle branch block (RBBB) pattern. During Re-HPS showing a LBBB pattern, the retrograde activation of the His bundle (H2) in response to V2 occurred via the left bundle branch (LBB), as indicated by inscription of retrograde H2 prior to RB2 in nine of 13 cases (average H2-RB2 = 9.4 msec), and simultaneous incription of retrograde H2 and RB2 in the remaining four. When V3 showed a RBBB pattern the retrograde RB2 preceded H2, suggesting H2 activation via the RBB. These findings suggest that circuit of Re-HPS incorporates both bundle branches and the bundle of His. The H-RB recordings were also useful in distinguishing sustained Re-HPS from atrioventricular nodal reentry when in both instances the QRS complex showed a LBBB pattern.
采用右心室额外刺激（V2）法和右束支（RBB）记录，同时结合传统的希氏束（H）记录，对13例患者希氏-浦肯野系统折返（Re-HPS）时的冲动传播途径进行了研究。窦性心律时的H-V和RB-V间期平均分别为44.2和27.6毫秒，顺行性H-RB间期平均为16.6毫秒。所有13例患者均表现为V3形式的Re-HPS，呈左束支阻滞（LBBB）图形，其中2例患者的V3还表现为右束支阻滞（RBBB）图形。在呈LBBB图形的Re-HPS期间，13例中有9例（平均H2-RB2 = 9.4毫秒）对V2的反应中希氏束的逆行激动（H2）经左束支（LBB）发生，表现为逆行H2在RB2之前记录到，其余4例中逆行H2和RB2同时记录到。当V3呈RBBB图形时，逆行RB2先于H2，提示H2经右束支激动。这些发现提示，Re-HPS的折返环包含两个束支和希氏束。当QRS波群均呈LBBB图形时，H-RB记录对于区分持续性Re-HPS和房室结折返也很有用。
