Nakazato Y, Nakata Y, Tokano T, Yasuda M, Ohno Y, Hisaoka T, Sumiyoshi M, Ogura S, Yamaguchi H, Ohi H
Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Pacing Clin Electrophysiol. 1994 Jun;17(6):1124-33. doi: 10.1111/j.1540-8159.1994.tb01470.x.
We compared His-bundle electrograms with pathological findings of the atrioventricular conduction system in four patients with complete atrioventricular intra-His block with narrow QRS complexes on ECG. Split His electrograms were recorded at the time of electrophysiological study. The patients died from noncardiac causes at 10 days, 1 year, 4 years, and 9 years, respectively, after the pacemaker implantation. Serial sections through the atrioventricular conduction system revealed strictly localized more than 50% reduction of conducting cells replaced by fibrosis at the branching portion of His bundle. The proximal portions of the bundle branches also exhibited decrease of the conducting cells showing a rough positive relation with the patient's age. Therefore, we considered that the H1 spikes seen on His-bundle electrograms originated from the penetrating portion of His, which was virtually intact in our cases, and that the H2 spikes originated from the right side of the distal branching portion of His.
我们对4例心电图显示QRS波群狭窄的完全性房室结内阻滞患者的希氏束电图与房室传导系统的病理结果进行了比较。在电生理研究时记录了分裂希氏束电图。这些患者在起搏器植入后分别于10天、1年、4年和9年死于非心脏原因。通过房室传导系统的连续切片显示，在希氏束分支处，传导细胞减少超过50%，被纤维化组织严格局限取代。束支近端的传导细胞也减少，与患者年龄呈大致正相关。因此，我们认为希氏束电图上的H1波峰起源于希氏束的穿透部，在我们的病例中该部位基本完整，而H2波峰起源于希氏束远端分支的右侧。
