Brusca A, Rosettani E, Mangiardi L, Bonamini R, Orzan F
Eur J Cardiol. 1977 Mar;5(2):183-99.
A case of bilateral bundle branch block is described with the following features: -- 2nd degree infranodal AV block due to bilateral, intermittently synchronous "phase 3" bundle branch block; -- occasional AV conduction failure due to concealed His bundle extrasystoles; -- right bundle branch block pattern due to retrograde activation from the left bundle branch; -- QRS complexes having normal duration due to uniform slow conduction in both bundle branches; -- Wenckebach phenomenon in the right bundle branch; -- concealed conduction in both branches. The above interpretations are based on the use of His bundle recordings, results of right atrial stimulation and of pharmacological testing. Determinations of the lengths of all H--H intervals, whether H was followed by a ventricular response or blocked, permitted insight into the mechanism of 2nd degree AV block with varying (right and left) bundle branch block.
描述了一例双侧束支传导阻滞，具有以下特征：——由于双侧间歇性同步的“3相”束支传导阻滞导致的二度结下房室传导阻滞；——隐匿性希氏束期前收缩引起的偶发房室传导失败；——左束支逆行激动导致的右束支传导阻滞图形；——由于双侧束支均匀缓慢传导，QRS波群时限正常；——右束支的文氏现象；——双侧束支的隐匿性传导。上述解释基于希氏束记录、右心房刺激结果及药理学测试。对所有H-H间期长度的测定，无论H波后是否跟随心室反应或阻滞，有助于深入了解伴有不同（右束支和左束支）束支传导阻滞的二度房室传导阻滞机制。
