Okada R, Fukuda K
Jpn Circ J. 1981 Apr;45(4):441-5. doi: 10.1253/jcj.45.441.
A microscopical study of the AV conduction system using a serial sectioning method, was performed on 81 autopsied hearts with blocks anywhere in the hearts without arrhythmia. Pre-blockade hypertrophy in the AV conduction system was seen in 38%, 38%, 50-58% corresponded respectively to 3 degrees AV block, 1-2 degrees AV block and bundle branch block (including left hemiblock). Post-blockade hypertrophy was also observed in 58%, 38% and 42-25% of the above mentioned types of blocks respectively. Hypertrophy anywhere in the AV conduction system was seen in 77%, 42%, 78%, 39%, 30% and 74% of the cases with blocks, sick sinus syndrome, pre-excitation syndrome, other arrhythmias, normal hearts and hypertrophied hearts without arrhythmia, respectively. Hypertrophy of the proximal AV conduction system to the bundle of His was specific for arrhythmia group, whereas hypertrophy of the bundle branches occurred in either hypertrophy without arrhythmia or in bundle branch block. Hypertrophy of the Purkinje cells was remarkable in sudden cardiac death by clinically-proved ventricular fibrillation. Incidence of sclerosis of the AV node artery was high in the arrhythmia group, especially the highest (90%) in the sudden death group.
采用连续切片法对81例无心律失常的心脏尸检标本进行了房室传导系统的显微镜研究。房室传导系统的阻滞前肥大在38%的标本中可见，38%、50 - 58%分别对应三度房室传导阻滞、一度至二度房室传导阻滞和束支传导阻滞（包括左束支阻滞）。上述类型阻滞的阻滞后肥大分别在58%、38%和42 - 25%的标本中观察到。房室传导系统任何部位的肥大分别在77%、42%、78%、39%、30%和74%的有传导阻滞、病态窦房结综合征、预激综合征、其他心律失常、正常心脏以及无心律失常的肥厚性心脏病例中可见。希氏束近端房室传导系统的肥大是心律失常组所特有的，而束支肥大则发生在无心律失常的肥厚或束支传导阻滞中。在经临床证实为心室颤动的心脏性猝死中，浦肯野细胞的肥大很明显。房室结动脉的硬化发生率在心律失常组中较高，尤其是在猝死组中最高（90%）。
