慢性双分支阻滞患者房室传导阻滞的发生率及部位

Incidence and site of atrioventricular block in patients with chronic bifascicular block.

作者信息

Dhingra R C, Wyndham C, Amat-y-Leon F, Denes P, Wu D, Sridhar S, Bustin A G, Rosen K M

出版信息

Circulation. 1979 Feb;59(2):238-46. doi: 10.1161/01.cir.59.2.238.

DOI:10.1161/01.cir.59.2.238

Abstract

Four hundred fifty-two patients with chronic bifascicular block and initially intact atrioventricular (AV) conduction were detected, studied, and prospectively followed between January 1970 and March 1978. There were 360 males and 92 females, ages 18--93 years (mean +/- SD, 62 +/- 15 years). Follow-up ranged from 29-2804 days (mean 1066 +/- 97 days). AV block (2 degrees or 3 degrees) developed in 29 patients, nine with apparent cause and spontaneously in 20. Cumulative annual incidence of all heart block for 1--5 years was, respectively, 4%, 5.9%, 8.7%, 10.1% and 11.3%, and for spontaneous block was 2%, 3.1%, 5.2%, 6.7%, and 7.1%. Sites of spontaneous block were probably or definitely AV nodal in ten, His bundle in one, and trifascicular in nine. Cumulative incidence of AV block in surviving bifascicular block patients is 11% at 5 years, with 7% reflecting spontaneous block. The probable or definite site of AV block varies and is trifascicular in less than half of the patients. The small incidence of trifascicular block probably explains the difficulty in predicting this complication with electrophysiological studies.

摘要

1970年1月至1978年3月期间，共检测到452例患有慢性双分支阻滞且最初房室传导正常的患者，并对其进行了研究和前瞻性随访。其中男性360例，女性92例，年龄在18 - 93岁之间（平均±标准差，62±15岁）。随访时间为29 - 2804天（平均1066±97天）。29例患者发生了房室阻滞（二度或三度），其中9例有明显病因，20例为自发发生。1 - 5年所有心脏阻滞的累积年发病率分别为4%、5.9%、8.7%、10.1%和11.3%，自发阻滞的累积年发病率分别为2%、3.1%、5.2%、6.7%和7.1%。自发阻滞的部位可能或肯定在房室结的有10例，在希氏束的有1例，在三分支的有9例。存活的双分支阻滞患者中，5年时房室阻滞的累积发病率为11%，其中7%为自发阻滞。房室阻滞可能或肯定的部位各不相同，不到一半的患者为三分支阻滞。三分支阻滞的发生率较低，这可能解释了通过电生理研究预测这一并发症的困难。