融合性期外収縮(Fused Premature Beat)による脚ブロックパターンの正常化現象の二例

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It has been experienced that the bundle branch block pattern disappears and the QRS interval is shortened only when some premature beats are accompanied by bundle branch block, which is an extremely rare phenomenon. Several cases of this rare phenomenon, making the bundle branch conduction appear temporarily normalized, have been reported since Wilson and Herrmann's description of it in 1920. In this paper, we will describe an extremely rare phenomenon of normalization in the proper bundle branch block pattern, resulting from the mutual intraventricular fusion of the atrial premature beat and the ventricular premature beat in I case of right bundle branch block and I case of left bundle branch block. Case 1. The ECG shown in Fig. I is the V_1 lead, exhiviting the right bundle branch block in the sinus rhythm. In the upper tracing (A), the atrial premature beats (APB) appear at the fourth beat and the final eighth beat, the coupling time being 0.56 to 0.57 sec. The sixth beat is one of the ventricular premature beats (VPB) exhiviting a typical left bundle branch block pattern, the coupling time being about 0.55 sec. In the lower tracing (B), the same atrial premature beats (APB) appear at the second beat, and the final eighth beat and the QRS complex at the fourth beat (FPB) show a pattern (rS type: QRS interval; 0.08 sec.) suggesting almost normal conduction of the bundle branch. Such a singular phenomenon can be observed provided the following 3 conditions are satisfied as shown in Fig. 2: i) existence of bundle branch block, ii) existence of atrial premature beats and ventricular premature beats originating from the distal region of the bundle branch block, and iii) approximation of the coupling times in these different premature beats. When these three conditions are satisfied, it is very likely that the supraventricular impulse will be fused with the ventricular impulse in the cardiac ventricle. As in this case, the left ventricle (normal side) is discharged from the atrial Premature impulse and the right ventricle (blocked side) is simultaneously discharged from the right ventricular impulse in the right bundle branch block. In other words, the retardation of the depolarization process of the ventricles characteristic of the bundle branch block disappears and the QRS interval, as well as the QRS pattern, is normalized.
社団法人日本循環器学会の論文
1973-11-20

融合性期外収縮(Fused Premature Beat)による脚ブロックパターンの正常化現象の二例

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