完全性左束支阻滞和右束支阻滞心电图结果分析

目的 了解完全性左束支阻滞和右束支阻滞不同性别、不同年龄的发生率情况.方法 分析108 610例常规心电图检测结果,分别统计完全性左束支阻滞和右束支阻滞不同性别、不同年龄的发生率情况.结果 108 610例门诊及住院患者资料,完全性左束支阻滞19例,占0.18％;右束支阻滞3 794例,占3.49％;完全性左束支阻滞发生率在不同性别之间差异无统计学意义（Х^2=1.707,P=0.191）,不同年龄之间比较差异有统计学意义（Х^2=209.874,P＜0.05）;右束支阻滞发生率在不同性别之间、不同年龄之间比较,差异均有统计学意义（Х^2=986.046,P＜0.05;Х^2=1 483.286,P＜0.05）.结论 60岁以上老年人的完全性左束支阻滞和右束支阻滞发生率较高,应定期进行常规心电图检查,及时发现异常情况并进行相应的处理.     

右束支阻滞图形伴电轴右偏的分支型室性心动过速一例

右束支阻滞图形伴电轴右偏的分支型室性心动过速一例周忆林陈春安胡永琼陈丽华（江汉油田中心医院内二科湖北潜江４３３１２４）患者男性，３０岁，因情绪激动突发心悸１日，以“室上性心动过速”（ＳＶＴ）入院。以往有类似发作，休息后可自行缓解。体格检查：Ｂｐ１２／...     

完全性左束支阻滞74例分析

文章报告我院1981年1月至1991年12月在48606例次心电图中检出完全性左束支阻滞(CLBBB)74例(200例次),其中41例男性,33例女性,最年青者18岁,最年长者86岁,平均63±114岁。≥60岁者45例(60.8％),40～59岁25例(33.8％)。高血压病及/或冠心病最常见(79.7％)。心肌病(9.5％)及心肌炎(5.4％)居第二位,伴发心律失常者55例(74.3％),电轴右偏2例(2.7％),且其中1例短时间内由右偏转向左偏.V_1导联呈QS型45例(60.8％),出现QV_5或QV_6 2例(2.7％).本文讨论了完全性左束支阻滞伴电轴左偏和右偏的机理,解释了出现QV_5或QV_6的机制,探讨了SV_1和SV_2的深度对左心室肥大的诊断价值,肯定了其QT间期延长与完全性左束支阻滞是密切相关的。     

房性心动过速伴间歇性完全性右束支阻滞

患者男,32岁。因心悸就诊。心电图示:Ⅰ、Ⅱ、Ⅲ、aVF、V_1～V_6的导联P波直立,aVR导联的P波倒置,P波形态相同,P-P间期匀齐,P-P之间有等电位线,心房率平均200次/min,房室传导比例2:1～4:3下传,P-R间期0.16s～     

完全性右束支阻滞并左后分支阻滞1例

患者女性,82岁。主因发热、咳嗽、咯痰1d。呼吸困难10h入院。血压120/60mmHg,心脏超声示:各房室腔大小形态正常。各瓣膜活动正常,左室舒张功能下降,二尖瓣,三尖瓣轻度返流,临床诊断:①肺部感染;②急性左心功能不全;图A为常规12导联心电图,各导联P波规律出现,Ⅱ、Ⅲ、aVF、V_4～V_6直立,aVR倒置,心率115次/min,PR 0.16s,QRs0.14s,QT0.34s,各导联QRS终末部粗钝,V_1呈R     

完全性右束支阻滞的心电图特征与临床病因关系

目的探讨完全性右束支阻滞（CRBBB）的心电图特征与临床病因的关系。方法依据病史、体检及辅助检查结果,将158例CRBBB分为器质性心脏病组（A组）及非器质性心脏病组（B组）,测量其相关的各项心电指标,并观察心律失常的情况。结果①A组86例,B组72例;②CRBBB电轴不偏者以B组多见;左偏以冠心病、高血压性心脏病（高心病）、甲状腺机能亢进性心脏病（甲心病）及心肌病多见,而风湿性心脏病（RHD）、肺源性心脏病（肺心病）、先天性心脏病（CHD）以右偏为主;③R／Sv。≤1、R’v1或Rv。〉1．5mV,QRS≥0．12s,V5、V6导联ST段下移≥0．1mV或T波倒置,并有心律失常这5项改变的发生率A组为17．7％,19％,14．6％,20．3％,25．3％;B组为2．5％,10．8％,3．2％,1．9％,1．23％。结论CRBBB以器质性心脏病多见,V5导联R／S≤1,QRS≥0．12s,V5、V6导联ST段下移或T波倒置,并有心律失常是诊断CRBBB伴器质性心脏病的可靠依据。     

完全性右束支阻滞病人气管插管期间的心电图变化

气管插管时可发生一过性高血压、心动过速、心律不齐、心动过缓等变化 ,且极易出现[1] 。我们观察 3 2例完全性右束支阻滞 (ＣＲＢＢＢ)病人气管插管期间的心电图变化 ,总结如下。1　资料与方法1 1　资料　术前诊断有ＣＲＢＢＢ的择期手术病人 3 2例 ,男 15例、女 17例 ;年龄3 5～ 67(平均 5 0 3 )岁 ,体重 48～ 70 (平均5 3 2 )ｋｇ。Ⅰ组为无明显器质性心脏病患者 ,共 18例 ;Ⅱ组为术前明确诊断有器质性心脏病的患者 ,共 14例 ,其中冠心病 6例 (42 9% )、高心病 2例(14 3 % ) ,肺心病 4例 (2 8 6% )。1 2　方法　术前常规禁食、禁饮 8…     

室颤伴完全性右束支阻滞

右束支阻滞(right bundle branch block,RBBB)可发生在正常人群,但较少,以儿童和青年人较多,并且以不完全性右束支阻滞较常见。完全性右束支阻滞发生率为0.25%~1.0%,绝大多数患者有器质性心脏病。RBBB可以发生在多种病理和生理情况下,其本身不产生明显的血流动力学异常,故临床上常无症状,如出现症状,多为原发疾病的症状,因此既往对此认识不足,重视不够,但是近年来发现RBBB与室颤的发生具有一定的相关性,并威胁患者生命。本文主要对右束支阻滞及室颤的相关研究及进展情     

完全性左束支阻滞的发生率及心电图特点

目的 观察受检者完全性左束支阻滞的发生率及心电图特点.方法 记录和分析86621例常规12导联同步心电图,分别统计完全性左束支阻滞(CLBBB)及右束支阻滞(RBBB)的发生情况及心电图特点.结果 检出完全性左束支阻滞(CLBBB) 170例,占0.19％;检出RBBB3243例(男2252例,年龄4～98岁;女991...     

伪装性右束支阻滞

1968年．Rosenbaum发现右束支阻滞合并间歇性左前分支阻滞，Ⅱ、Ⅲ导联S波加深的同时，I、aVL导联的S波可以消失．并将这种左前分支阻滞图形掩盖肢体导联右束支阻滞表现的现象称为伪装性束支阻滞（masquerading bundle branch block）。     

The pathologic correlates of the electrocardiogram: complete left bundle branch block

To assess whether gross pathologic differences exist between hearts with left bundle branch block (LBBB) and left-axis deviation (LAXD) and those with LBBB and a normal frontal plane axis, we examined 70 hearts with LBBB in a series of 1410 sequential dissections (5%). Thirty-two hearts had LAXD and 34 had normal axes on the correlative ECG. Left ventricular enlargement occurred frequently (93%). No significant differences were found in age distribution, left ventricular weight, coronary anatomy or infarct location. Quantitative analysis revealed larger inferoposterolateral and apical infarcts in hearts with LBBB and LAXD (p less than 0.01). The accuracy of various electrocardiographic signs of left ventricular enlargement and myocardial infarction in the presence of LBBB was assessed. Voltage criteria and QRS duration poorly define anatomic chamber enlargement. Anterior infarction is suggested by a q or pathological Q wave in lead I, a q wave in leads I, V5 and V6, or notched S waves in V3 or V4. Pathologic q waves or ST shifts in the inferior leads have high diagnostic specificity but low sensitivity for inferior infarction.     

Long term followup of incomplete right bundle branch block: The risk of development of complete right bundle branch block

The purpose of this study was to examine the long term prognosis of ‘so-called’ incomplete right bundle branch block (RSR¹ in V1 or V2) from the perspective of the risk of occurrence of complete right bundle branch block. The Manitoba Study consists of a cohort of 3983 men who have been followed with regular examinations, including ECGs since 1948. Six hundred and twenty–six cases with R¹ in the right precordial leads were observed from the time of their first 12 lead ECG to the end of the observation period in 1977. Ten cases of right bundle branch block occurred in this group. Although the number with complete right bundle branch block is small, it was significantly (p <0.05) greater than the number of cases expected, based on calculations of the incidence rate in the entire cohort. The age adjusted incidence rate for complete right bundle branch block was 1.76/1000 person years in those with R¹ in leads V1 or V2, and 0.44/1000 person years in those without R¹ in V1 or V2. The age adjusted incidence of complete right bundle branch block was greater in persons with R¹ in V1 or V2 and QRS duration less than 0.10 sec. (1.22/1000 person years) than those without R¹ in these leads (0.44/1000 person years) but the observed number of cases was not significantly greater than expected. In those with R¹ and QRS duration of 0.10 sec. or greater and less than 0.12 sec, the age adjusted incidence rate was 3.03/1000 person years and a significant (p <0.05) greater number of cases was observed than expected. In addition the time interval between the detection of R¹ in V1 or V2 and development of complete right bundle branch block was significantly (p <0.05) shorter in those with wider QRS compared to a narrower QRS (4.2 versus 15.8 years respectively).This data suggests that an R¹ in the right precordial leads represents a form of impaired conduction in the right bundle branch system, especially when associated with a QRS duration between 0.10 to 0.12 seconds because of the increased likelihood of complete right bundle branch block.     

左束支起搏对合并右束支传导阻滞患者的心电学影响

目的探讨左束支起搏对症状性心动过缓合并右束支传导阻滞患者的心电学影响。 方法连续纳入2019年1月1日至2021年12月31日因症状性心动过缓合并完全性右束支传导阻滞并在厦门大学附属心血管病医院心内科拟行左束支起搏的患者,记录标准12导联体表心电图。比较左束支起搏术前与术后V₁导联QRS波形态、QRS时限、右心室延迟激动时间（dRVAT）、左心室达峰时间（LVAT）及心室间延迟时间（IVD）的差异。 结果共入选53例患者,年龄（72.15±9.39）岁,男34例。其中46例（86.79%,46/53）成功完成左束支起搏。术前V₁导联以rsR’型为主38例（38/46,83%）,术后QRS形态以Qr型为主29例（29/46,63%）。左束支起搏可以显著缩短QRS时限［（149.09±12.81）ms对（112.46±9.64）ms,P<0.001）］,其中35例（76.08%,35/46）患者的QRS时限完全纠正,10例（21.73%,10/46）部分纠正,1例（2.17%,1/46）未纠正;IVD显著缩短［（58.28±12.54）ms对（34.34±8.87）ms,P<0.001］;但在dRVAT方面左束支起搏术前与术后差异无统计学意义［（100.47±12.40）ms对（100.86±10.57）ms,P=0.955］。与术前相比,左束支起搏延长LVAT［（42.46±6.95）ms对（66.53±10.83）ms,P<0.001］。 结论左束支起搏可显著缩短完全性右束支传导阻滞患者的QRS时限,并改善其心室间电学同步性,产生以Qr型为主的起搏后QRS波形态。     

新发右束支传导阻滞378例临床诊治分析

目的探讨新发右束支传导阻滞流行病学、临床特点及预后,为临床诊治提供参考。方法通过临床诊治观察、病历分析、出院随访,对378例新发右束支阻滞患者资料进行统计分析。结果新发右束支阻滞主要见于急性心肌梗死(AMI),共253例(占66.9%),其中老年人167例,占84.8%;其次见于肺栓塞、高血压、肺心病、心脏创伤、炎症等。结论新发右束支传导阻滞,多见于老年人大面积急性心肌梗死,病情危重、病死率高。     

Vectorcardiographic study on the right hypertrophy diagnosis in complete right bundle branch block]

Vectorocardiograms were led and interpreted by means of quantitative and qualititive criteria in 100 children with a complete block of the right bundle-branch occurring after correcting surgery of tetralogy of Fallot or isolated defect or the ventricular septum. The results are discussed after demonstrating the pathophysiological patterns of excitation associated with right ventricular hypertrophy and complete block of the right bundle-branch. After a survey of the literature a precise summary of the results is given in order to distinguish clearly by differential diagnosis necessary for postoperative observation of the vitiae cordis mentioned above, between complete block of the right bundle-branch and right ventricular hypertrophy. 4 vetorcardiograms were selected out of the total number of loops for demonstration of the defined criteria for right ventricular hypertrophy associated with complete block of the right bundle-branch.     

Optimal interpretation of the supine exercise electrocardiogram in patients with right bundle branch block

A detailed analysis of the exercise ECG was performed in 82 patients with right bundle branch block who underwent supine exercise equilibrium radionuclide angiography. The sensitivity and specificity of each individual electrocardiographic lead for the detection of a positive radionuclide angiogram was determined. Leads V5 and V6 had a sensitivity of 58 percent and a specificity of 89 percent. The limb leads and lead V4 had a lower sensitivity, but an equivalent specificity. Leads V1 and V3 each had a clearly lower specificity that ranged from 56 to 67 percent. Receiver operating characteristic curve analysis demonstrated that the optimal interpretation of the exercise ECG included the limb leads and V4 to V6, but not V1 to V3. The results of coronary angiography in the subset of 16 patients who underwent this procedure confirmed these findings.