Kawasuji M, Iwa T
Jpn Circ J. 1978 Sep;42(9):1041-56. doi: 10.1253/jcj.42.1041.
Electrophysiologic mapping was performed on 29 dogs and 35 patients to investigate the ventricular excitation sequence of normal hearts and various cardiac lesions exhibiting the electrocardiographic pattern of right bundle branch block (RBBB). The activation times of epicardial surface were referenced to the onset of left ventricular cavity potential or QRS wave of lead II ECG. Epicardial activation sequence was represented by isochrones. 1. In normal hearts, the earliest epicardial breakthrough occurred at the mid-anterior paraseptal area in the right ventricle and the activation spread in a circular fashion. In the left ventricle, the epicardial activation occurred at three areas and then spread to the posterobasal area. The epicardial activation sequence was a good representation of the ventricular excitation. 2. In RBBB due to trauma to the main right bundle branch, the right ventricular activation showed marked delay and the characteristic V-shaped pattern. 3. Following vertical ventriculotomy, the right ventricular epicardial activation showed marked delay at sites distal to the incision but no significant delay proximal to it. Regarding postoperative RBBB, central right bundle branch injury was able to be differentiated from distal Purkinje injury due to right ventriculotomy by means of epicardial mapping. 4. In left ventricular pacing, the activation spread in a circular fashion with the prolonged right ventricular activation. 5. In ostium secundum defect, the right ventricular epicardial activation sequence showed various patterns of activation delay resulting from right ventricular hypertrophy. In ostium primum defect, the earliest epicardial activation was found in the left posterior paraseptal area, and the right ventricular activation showed a normal pattern with some delay. Epicardial mapping has been the precise representation of ventricular excitation by direct measurement of cardiac potentials. Cardiac lesions exhibiting the electrocardiographic RBBB pattern provided various patterns of the right ventricular activation delay according to the geneses of RBBB.
对29只犬和35例患者进行了电生理标测，以研究正常心脏以及表现出右束支传导阻滞（RBBB）心电图模式的各种心脏病变的心室激动顺序。心外膜表面的激动时间以左心室腔电位的起始点或II导联心电图的QRS波为参照。心外膜激动顺序用等时线表示。1. 在正常心脏中，最早的心外膜突破发生在右心室前中隔旁区域，激动呈环形传播。在左心室，心外膜激动发生在三个区域，然后扩散到后基底区域。心外膜激动顺序很好地反映了心室激动。2. 在主要右束支受创伤导致的RBBB中，右心室激动明显延迟，呈现特征性的V形模式。3. 垂直心室切开术后，右心室心外膜激动在切口远端部位明显延迟，但在切口近端无明显延迟。关于术后RBBB，通过心外膜标测能够区分右束支中央损伤与右心室切开术导致的远端浦肯野损伤。4. 在左心室起搏时，激动呈环形传播，右心室激动时间延长。5. 在继发孔型缺损中，右心室心外膜激动顺序因右心室肥厚而呈现各种激动延迟模式。在原发孔型缺损中，最早的心外膜激动出现在左后中隔旁区域，右心室激动呈正常模式但有一定延迟。心外膜标测通过直接测量心脏电位精确地反映了心室激动。表现出心电图RBBB模式的心脏病变根据RBBB的病因提供了各种右心室激动延迟模式。
