束支传导阻滞临床意义的探讨

应用电生理方法检查束支阻滞患者13例,包括单支阻滞4例,双支阻滞9例。发现H-V间期正常8例,延长5例;合并病态窦房结综合征和隐匿性房室结内阻滞各1例。平均随访252天。H-V延长患者均有程度不等的脑缺血神经症状(以眩晕和黑朦多见),其中1例发展至完全性房室阻滞并作永久起搏;H-V正常者仅少数(2/8)有神经症状,无一作永久起搏。单支阻滞患者神经症状少见(1/4);双束支阻滞则多数(6/9)有症状,且往往伴器质性心脏病。作者认为,H-V显著延长伴明显神经症状和(或)第二度以上房室阻滞者应作预防性起搏。

CLINICAL VALUE OF BUNDLE BRANCH BLOCK

Thirteen patients with bundle branch block, (4 unifascicular and 9 bifascicular), underwentclinical electrophysiologic examination. Eight had a normal H-V interval and 5 had prolongedH-V interval. The mean follow-up period was 252 days. Transient cerebral symptoms occurredamong all of the patients with prolonged H-V interval and one received permanent pacemakerbecause of complete atrioventricular block. Only 2/8 patients with normal H-V interval had-cerebral symptoms and nobody received pacemaker. One of 4 patients with unifascicular blockhad cerebral symptoms while 6/9 patients with bifascicular block had symptoms. The authorsuggested that prophylactic pacing is indicated for marked prolongation H-V intervalaccompanied by cerebral symptoms and / or second or high degree atrioventricular block.