双分支和三分支阻滞时QRS电轴左偏的电生理意义

Electrophysiologic significance of leftward QRS axis deviation in bifascicular and trifascicular blocks.

作者信息

Ducceschi V, Sarubbi B, D'Andrea A, Liccardo B, Lucca P, Mayer M S, Scialdone A, Santangelo L, Iacono A

机构信息

Seconda Università di Napoli, Facoltà di Medicina e Chirurgia, Italy.

出版信息

Clin Cardiol. 1998 Aug;21(8):579-83. doi: 10.1002/clc.4960210809.

DOI:10.1002/clc.4960210809

PMID:9702385

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6655374/

Abstract

BACKGROUND

Intraventricular conduction disturbances determine complete impairment of impulse propagation along the right or left bundle branch or the two left fascicles.

HYPOTHESIS

This study was undertaken to investigate the electrophysiologic significance of QRS axis (QRSA) orientation in bifascicular and trifascicular blocks.

METHODS

A group of 76 subjects, 43 with right bundle-branch block (RBBB) and left anterior hemiblock (LAH) (Group A), and 33 with left bundle-branch block (LBBB) (Group B), was submitted to electrophysiologic evaluation.

RESULTS

In Group A, QRSA was inversely related only to intraventricular conduction, while in Group B, QRSA inversely related to infrahisal conduction times. A value of < -60 degrees was considered the cut-off point for determining subjects with a considerable leftward QRSA deviation. Of the 27 Group A patients with a QRSA < -60 degrees, 38.5% developed an infrahisal second-degree atrioventricular (AV) block during incremental atrial stimulation (IAS) in comparison with 11.1% of those with QRSA > -60 degrees. Of the 9 Group B patients with a QRSA < -60 degrees, 44.4% exhibited severe impairment of infrahisal conduction at baseline and 66.6% developed an infrahisal second-degree AV block during IAS, whereas among the remaining 24 with a QRSA > -60 degrees, in only 8.3% were both infrahisal (HV1 and HV2) intervals dangerously prolonged, and 23.8% encountered an infrahisal second-degree AV block during IAS. In Group A, atrioventricular conduction time > 200 ms exhibited a better predictive accuracy than QRSA < -60 degrees for the development of an infrahisal second-degree AV block during IAS, whereas the latter appeared the best noninvasive predictor in Group B with a slightly lesser predictive accuracy than HV > 80 ms.

CONCLUSION

The degree of leftward QRSA deviation seems to reflect the entity of intraventricular conduction delay in patients with RBBB + LAH, while it appears to be directly related to infrahisal conduction prolongation in those with LBBB.

摘要

背景

室内传导障碍决定了冲动沿右束支或左束支或左束支两个分支的传导完全受损。

假设

本研究旨在探讨双分支和三分支阻滞中QRS电轴（QRSA）方向的电生理意义。

方法

对76名受试者进行电生理评估，其中43例为右束支阻滞（RBBB）合并左前分支阻滞（LAH）（A组），33例为左束支阻滞（LBBB）（B组）。

结果

在A组中，QRSA仅与室内传导呈负相关，而在B组中，QRSA与希氏束下传导时间呈负相关。< -60度的值被认为是确定QRSA明显向左偏移受试者的分界点。A组中27例QRSA < -60度的患者，在递增心房刺激（IAS）期间，38.5%发生希氏束下二度房室（AV）阻滞，而QRSA > -60度的患者中这一比例为11.1%。B组中9例QRSA < -60度的患者，44.4%在基线时希氏束下传导严重受损，66.6%在IAS期间发生希氏束下二度AV阻滞，而其余24例QRSA > -60度的患者中，仅8.3%的希氏束下（HV1和HV2）间期危险地延长，23.8%在IAS期间发生希氏束下二度AV阻滞。在A组中，房室传导时间> 200 ms对IAS期间希氏束下二度AV阻滞发生的预测准确性优于QRSA < -60度，而在B组中，后者似乎是最佳的非侵入性预测指标，但其预测准确性略低于HV > 80 ms。