Talbot S
Angiology. 1977 Jan;28(1):19-30. doi: 10.1177/000331977702800104.
A total of 1342 electrocardiograms demonstrating intraventricular conduction defects were reviewed. Criteria for distinguishing different types of conduction defects and combinations of such defects are presented. The time of intrinsicoid deflection was of great value and may be used to distinguish lesions of the main fascicles and peripheral Purkinje conduction defects. However multiple peripheral defects affecting a large area of myocardium can produce a pattern identical to left bundle branch block. It is suggested that intrinsicoid deflection time should be measured from the beginning of the QRS to the onset of the longest downslope at or after the peak of the R wave. It should be carefully related to the voltage of the dominant wave of the QRS complex in each lead. If intrinsicoid deflection is delayed in a limb lead that does not show the maximum voltage of the QRS, a peripheral left ventricular conduction defect is present; but if the lead does show the maximum voltage of the QRS, the defect may be central or peripheral. Another useful electrocardiographic feature was the direction of both the initial and terminal QRS forces in the 12-lead electrocardiogram. Such analysis often resolved the diagnosis of hemiblocks when the axis was indeterminate.
共回顾了1342份显示室内传导阻滞的心电图。文中给出了区分不同类型传导阻滞及此类阻滞组合的标准。室壁内传导时间具有重要价值，可用于区分主要束支病变和外周浦肯野传导阻滞。然而，影响大面积心肌的多个外周缺陷可产生与左束支传导阻滞相同的图形。建议从QRS波起始点至R波峰值处或之后最长下降支的起始点测量室壁内传导时间。应仔细将其与各导联中QRS波群主波的电压相关联。如果在未显示QRS波最大电压的肢体导联中室壁内传导延迟，则存在外周左心室传导阻滞；但如果该导联确实显示了QRS波的最大电压，则缺陷可能是中心性的或外周性的。另一个有用的心电图特征是12导联心电图中QRS波初始和终末向量的方向。当电轴不确定时，这种分析常常有助于明确半阻滞的诊断。
