Csapo G, Weisswange A
Br Heart J. 1978 Oct;40(10):1153-64. doi: 10.1136/hrt.40.10.1153.
A change in the voltage and character of the His bundle deflection following premature atrial stimuli was observed and analysed in 5 of 95 patients having intracardiac conduction studies because of AV conduction disturbances. Of these 5 patients, 3 had spontaneous block within the His bundle, 2 of them showing block in other segments of the conduction system. With increasing prematurity of programmed atrial stimuli, there was a progressive decrease in the voltage of the His deflection, followed by a split His deflection, and finally disappearance of the His deflection. The voltage of the His deflection was also reduced in sinus beats following spontaneous His bundle premature beats. Similarly, during atrial stimulation at increasing rates, the His deflection decreased in voltage, split, and finally disappeared, but when Wenckebach periods appeared the His deflection reappeared in the first paced beat after the dropped beat. The preceding H-H interval was the only electrophysiological variable consistently related to the changes in the His deflection. These changes in His deflection can be explained electrophysiologically as the result of a conduction disturbance within the His bundle. The clinical significance of the phenomenon is discussed. The occurrence of this phenomenon during a conduction study makes it difficult or even impossible to localise the AV block precisely.
在因房室传导障碍而进行心内传导研究的95例患者中，对其中5例患者在房性早搏刺激后希氏束电位的电压和特征变化进行了观察和分析。在这5例患者中，3例在希氏束内出现自发性阻滞，其中2例在传导系统的其他节段出现阻滞。随着程控心房刺激提前程度的增加，希氏束电位的电压逐渐降低，随后希氏束电位分裂，最终希氏束电位消失。在希氏束自发性早搏后的窦性搏动中，希氏束电位的电压也降低。同样，在心房刺激频率增加时，希氏束电位的电压降低、分裂，最终消失，但当出现文氏周期时，在漏搏后的第一个起搏搏动中希氏束电位再次出现。之前的H-H间期是唯一与希氏束电位变化始终相关的电生理变量。希氏束电位的这些变化在电生理上可解释为希氏束内传导障碍的结果。讨论了该现象的临床意义。在传导研究过程中出现这种现象使得精确确定房室阻滞的部位变得困难甚至不可能。
