三分支阻滞合并室性逸搏引致多种形态的室性融合波

患者男性,46岁,反复胸闷、心悸3年,先后晕厥2次。体检发现左心室增大,心律不齐。临床诊断:冠心病。附图Ⅱ导联(上行)前几个窦性P波呈2:1房室传导,下传QRS(R_(1、2、3))为完全性右束支阻滞。随后窦率减慢,出现1:1房室传导。R_(4、5、6)负波增加,电轴变为-55°P-R由0.16s延长至0.20s,提示在右束支阻滞基础上出现“完全性”左前分支阻滞和Ⅰ°左后分支阻滞。R_7的图形、电轴以及P-R间期(0.18s)均介于前两种QRS之间,表现为完全性右束支阻滞、“不完全性”左     

克山病、心肌炎及先天性心脏病束支传导阻滞的临床分析

目的 探讨束支传导阻滞对克山病、心肌炎及先天性心脏病的临床意义。方法 选择602例小儿克山病、275例小儿心肌炎和110例先天性心脏病患进行心电图检查，并以6117例健康儿童作对照，不完全性右束支传导阻滞分为5型对比分析。结果 完全性右束支传导阻滞的检出率，克山病为14．8％，先天性心脏病1．8％，心肌炎0．4％，健康儿童0．08％。不完全性右束支传导阻滞的检出率，克山病为11．5％，先天性心脏病8．2％，心肌炎6．9％，健康儿童5．3％；克山病、心肌炎及先天性心脏病以R波升支切迹越过基线的不完全性右束支传导阻滞多见，健康儿童以R波降支切迹不越过基线及S波切迹的不完全性右束支传导阻滞多见。左前分支阻滞的检出率以心肌炎最高。完全性左束支传导阻滞及左后分支阻滞仅见于克山病。结论 完全性右束支传导阻滞、完全性左束支传导阻滞、左后分支阻滞及左前分支阻滞主要见于器质性心脏病患，不完全性右束支传导阻滞可见于器质性心脏病患，也可见于健康儿童。     

房性早搏二联律伴交替性左前分支裂隙现象一例

患者男性,48岁。因胸闷、心悸1个月加重2天就诊。心电图:房性早搏(简称房早)二联律伴右束支传导阻滞合并交替性左前分支传导阻滞型室内差异传导。房早出现较晚时,P′R间期正常,QRS波呈右束支合并左前分支传导阻滞图形;房早出现较早时,P′R间期明显延长,QRS波仅呈右束支传导阻滞图形,左前分支传导阻滞消失。结论:房早时,左前分支发生交替性裂隙现象可能是本现象的主要机制。     

不完全性与完全性右束支传导阻滞图形交替4例

例3患者男性,78岁。临床诊断:冠心病。常规12导联同步记录(图3)可见窦性心律,心率79图1 说明见正文。例1患者男性,29岁。临床诊断:病毒性心肌炎后遗症。心电图(图1)示窦性心律,心率115次/min,P-R间期恒定为0.15s,QRS波群呈不完全性右束支传导阻滞型(0.11s)与完全性右束支传导阻滞型(0.14s)1∶1交替,同时ST-T亦伴随着QRS波群变化呈相应变化。QRS平均电轴约在-63°～-67°交替。当窦性心率减慢到100次/min以下时,QRS波群全部恢复正常(图略)。心电图诊断:窦性心动过速,3相不完全性与完全性右束支传导阻滞交替,左前分支阻滞。例2患者…     

交替性完全性左、右束支阻滞一例

交替性完全性左、右束支阻滞，因其可发展为完全性房室传导阻滞而出现阿-斯综合征，故具有较高的临床诊断意义。现介绍一例患者，其表现为 P-R 间期不一致的左、右束支传导阻滞交替出现。     

短暂交替性三分支阻滞1例

患者男性,17岁,因先天性心脏病、室间隔缺损而住院行室间隔修补术,术后第2天出现心律不齐而检查心电图(附图,见第172页)。附图上行为肢导联和V_1导联,QRS波群:I、aVL呈qRS型,Ⅱ、Ⅲ、aVF呈rS型伴S波挫折,RaVL>RⅠ,SⅢ>SⅡ,V_1呈R型并粗钝。各导联QRS波群宽均≥0.12s并伴有明显的终末部粗钝或挫折。电轴左偏,P-R间期延长约0.30s,诊断为不完全性三分支传导阻滞(完全性右束支传导阻滞、左前支阻滞,左后分支传导延缓)。下行Ⅱ导联呈室性早搏二联律,但早搏QRS形态也分2种,随着它前面QRS波群的形态不同而不同。窦性下传的第1、5、9、13个QRS波群呈rS型,并有S波挫折,QRS波群宽0.14s,P-R间期0.30s,这种QRS波群的形态与常规记录的Ⅱ导联完全相同,其后的室早呈QS型,时限比正常下传的更宽,     

坐位性间歇性左后分支与持续性左前分支及右束支阻滞并存1例

患者男性,44岁,平素健康,体检时心电图示左前分支阻滞。1991年8月因运动后心悸、头晕就诊,心电图和心电向量图示:左前分支阻滞及不完全性右束支阻滞,二维超声心动图、血脂分析、血糖等各项检查均正常。次月坐位心电图V_5导联(附图A)突然转为完全性左束支阻滞,且P-R 延长至0.22—0.24s,较原先卧位时延长0.04—0.06s,接着再作常规导联(附图B)     

罕见的不同程度的四分支阻滞

患者男性,67岁.1977年因胸闷、心前区不适就诊,经全面检查确认为冠心病.当时心电图诊断发现有双分支传导阻滞:不完全性右束支传导阻滞和左前分支传导阻滞(图略).给予扩冠治疗.1993年1月3日病人因心绞痛发作频繁再次来院,心电图(图1上)比前次有明显变化,呈现三分支传导阻滞:完全性右束支传导阻滞、左前分支传导阻滞及间隔支阻滞,只有左后分支传导正常.随即入院检查治疗.同月10日复查心电图(图1下)仍为三分支阻滞,但胸前导联V_2—V_4出现明显的小q波,经过治疗症状缓解后出院.同年10月5日因突然晕厥、抽搐、意识不清而再次入院,心电图(图2)示:窦     

束支传导阻滞和脑血管意外病人的Q—T间期与J—T时间对比分析（摘要）

对100例受试者的 Q-T 间期与 J-T 时间作了对比分析。100例受试者中包括正常对照组20例(经病史、体检、X 线胸片及心电图检查等均正常者)。左前分支传导阻滞20例、完全性右束支传导阻滞20、完全性左束支传导阻滞20例、脑血管意外组20例,均为初次发病,既往病史和本次心电图检查均无束支阻滞的记录,心电图上测定 QRS、Q-T、R-R 间距分别在Ⅰ、     

间歇性双束支传导阻滞1例

患者男,72岁。临床诊断:原发性高血压,冠心病。曾描记心电图为窦性心律,完全性右束支传导阻滞。入院前因情绪激动突然出现心悸、胸闷、气促及头昏,但无晕厥。当即描记心电图为三度房室传导阻滞。给予扩张冠状动脉、营养心肌及地塞米松等治疗,病情好转。在治疗期间检查心电图发现房室传导及束支传导情况多变。入院时V_1导联心电图(附图上)见P波规律出现,P-P间期0.72s,心房率83次/min,心室率40次/min,每2个P波有1个P波下传心室,P-R间期0.12s,下传的QRS呈右束支传导阻滞型。心电图诊断:莫氏Ⅱ型房室传导阻滞(2:1下传)伴完全性右束支传导阻滞。附图中见P-P规则,P-P间期0.48s,心房率125次/min;R-R间期不等,分别为1.08s、1.20s、1.40s,平均心室率49次/min,房室传导比例为2:1—3:1。QRS波群呈3种形态:第2、5个QRS形态正常,呈rS型,P-R间期0.12s;第3、6个QRS呈左束支传导阻滞型,P-R0.44s;第1、4个QRS呈右束支传导阻滞型,P-R间期0.12s。心电图诊断:高度房室传导阻滞(2:1—3:1),间歇性双束支传导阻滞。附图下见P波规律出现,心率88次/min,P-R间期0.12s,QRS波群呈rsR＇型。心电图诊断:窦性心律,完全性右束支传导阻滞。     

An example of combined sinoatrial and atrioventricular block

Combined sinoatrial and atrioventricular block is rare and has been reported in patients on digitalis. We report a case of combined Mobitz type II sinoatrial block and 2:1 atrioventricular block in a patient on no medication who presented with recurrent syncope.     

Complete atrioventricular block during cardiac catheterization: Two case reports in patients without pre-existing conduction abnormalities

Third-degree atrioventricular block has been well documented during ventricular catheterization of patients with underlying conduction abnormalities. Two cases reported here describe patients with normal conduction at baseline who sustained complete heart block during ventricular catheterization. Catheterizing physicians should be aware of this risk, which has not been previously reported.     

Case Report: Type I Second-Degree AV Block Masquerading as Type II Block

This report describes a patient with type I second-degree atrioventricular block and sequences consistent with type II block according to widely accepted criteria. The electrocardiograms illustrate the importance of deductive reasoning and the clinical context in the diagnostic evaluation of perplexing forms of second-degree AV block.     

Apparent bradycardia-dependent right bundle branch block associated with atypical atrioventricular Wenckebach periodicity as a possible mechanism

The Holter monitor electrocardiogram was taken from a 15-year-old male athlete. Intermittent right bundle branch block frequently occurred at rest. When sinus cycles gradually lengthened, sinus impulses were conducted to the ventricles with right bundle branch block (RBBB) in succession. When, thereafter, sinus cycles gradually shortened, sinus impulses were conducted without RBBB. However, it seems that these findings do not show true bradycardia-dependent RBBB. Atypical atrioventricular Wenckebach periodicity was occasionally found in which sudden shift from the period of comparatively short PR intervals to the period of long PR intervals occurred. In the Wenckebach periodicity, when a QRS complex occurs after a much longer pause, RBBB was not found, while when it occurs after a much shorter period, RBBB was found. This suggests that this case may be apparent bradycardia-dependent RBBB, namely, a form of tachycardia-dependent RBBB. This is the first report suggesting apparent bradycardia-dependent bundle branch block associated with gradual lengthening of sinus cycles, as a possible mechanism.     

AV block. Which type and where?

An electrocardiogram (ECG) showing sinus tachycardia with sinus rate exceeding the ventricular rate suggesting atrio-ventricular (AV) block in a patient with old anterior wall infarction is presented. The presence of varying PR intervals, irregular RR intervals and P-QRS relationship not consistent with 2nd degree type 1 AV block was seen. The possible site(s) and degree of AV block in the case is discussed.     

Phase 4 paroxysmal AV block in a patient with scleroderma

A 72-year-old man with limited cutaneous systemic scleroderma was hospitalized for two episodes of witnessed syncope. The baseline 12-lead electrocardiogram was normal but on telemetry there were numerous episodes of paroxysmal AV block with asystolic periods of up to 7.5 s duration. Analysis of the rhythm strips revealed phase 4 intra-His bundle block characterized by critical P-P intervals that triggered the AV block, and a narrow range of junctional escape to subsequent P wave intervals that were required to release the AV block. A dual chamber pacemaker was implanted.     

Occurrence of complete heart block associated with acute renal infarction

Complete heart block (CHB) and acute renal infarction (ARI) are both uncommon diseases and seldom encountered in the clinical practice. We describe a rare case of pre‐existing left bundle branch block, presenting simultaneously with CHB and ARI. The possible mechanism depends on prior presence of either CHB or ARI. If ARI occurs first, severe pain and embolism may enhance the vagal tone resulting in decrease in the heart rate and transient intraventricular conduction interruption, which subsequently causes CHB. The opposite scenario, CHB preceding ARI, is also possible. CHB can be physiologic and transient, with higher risk of development in the circumstance of pre‐existing conduction system disturbances. Patients with CHB are predisposed to formation of thrombi and thromboemboli, giving rise to ARI. In conclusion, awareness and timely identification of the clinical manifestations of these two diseases may facilitate early diagnosis and prompt management.     

Resumption of interatrial conduction after atrial premature beat in baseline interatrial aberrancy

Interatrial block (IAB) is a delay or blockage of interatrial conduction from the right atrium to the left atrium, causing prolongation of the P-wave duration on the electrocardiogram. This condition is unfortunately not uncommon in clinical practice, especially among the elderly. It is often overlooked because the P wave is small and abnormalities can be difficult to detect. An isolated IAB does not usually cause any abnormal symptoms and may not require any specific treatment. Nevertheless, a relationship between an IAB and other cardiovascular conditions including left atrial electromechanical dysfunction, atrial remodeling, atrial fibrosis, atrial fibrillation, and stroke has been reported. Early diagnosis of this condition is critical. This case report presents a functional interatrial block or interatrial aberrancy that returned to normal after an atrial premature complex where the interatrial conduction remained normal in subsequent beats.     

Mobitz Type II Second‐Degree Atrioventricular Block with Narrow QRS and Junctional Extrasystoles: What is the Mechanism?

A 74‐year‐old man underwent an electrophysiological study because of Mobitz type II second‐degree atrioventricular (AV) block with narrow QRS and frequent junctional extrasystoles. During the study, there were very frequent single His bundle depolarizations with multiple coupling intervals that reproduce the ECG findings. In this case, some His bundle extrasystoles result in retrograde concealed conduction and prolonged local refractoriness in the AV node that manifest as block of the next atrial impulse.