Slama R, Sebag C, Motté G, Leclercq J F
Arch Mal Coeur Vaiss. 1981 Jul;74(7):837-43.
The authors describe the analysis of a case of atrial flutter with a slow ventricular response, the block being 9:2 with a first RR interval measuring between 3 and 4 PP intervals and a second RR interval between 5 and 6 PP intervals, the second of the 2 RR intervals being exactly 9 PP intervals. The only possible explanation of this sequence is firstly a 3:1 intranodal block (Wenckebach 3:2 in the central zone N of the node and 2:1 block at the nodo-hisian junction) followed by a 3:2 infra- or intra-hisian Wenckebach phenomenon. The His bundle recordings during flutter confirmed this hypothesis with the recording of a 3:2 block after the H potential. When sinus rhythm was restored at atrial level, the intrahisian conduction defect persisted (2:1 or 3:2 Wenckebach block).
作者描述了一例伴有缓慢心室反应的心房扑动病例分析，其阻滞呈9:2，第一个RR间期为3至4个PP间期，第二个RR间期为5至6个PP间期，这两个RR间期中的第二个正好为9个PP间期。对此序列唯一可能的解释首先是3:1的结内阻滞（在结的中央区N为文氏3:2阻滞，在结希氏交界区为2:1阻滞），随后是希氏束内或希氏束下的3:2文氏现象。心房扑动期间的希氏束记录通过H波后3:2阻滞的记录证实了这一假设。当心房水平恢复窦性心律时，希氏束内传导缺陷持续存在（2:1或3:2文氏阻滞）。
