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文氏现象可发生在心脏传导系统的任何部位,而发生在分支内的文氏现象较为罕见。我们遇到1例直接显示性左后分支内文氏型传导阻滞,特报道如下。心电图分析附图为1981年11月24日心绞痛发作时的心电图记录,示窦性心律不齐,P-P间距最大互整0.13秒,平均心率86次/分,P-R间期固定为0.16秒,QRS时限恒定为0.08秒。肢体导联以4或5个心动为一组呈现QRS形态规律性改变,以各联第一个QRS开始,Ⅰ,aVL导联S波逐渐增深,而Ⅱ、Ⅲ、aVF导联的R波逐渐增高,额面QRS电轴(Ⅱ、Ⅲ导联)由+82°逐渐偏移至+124°(+82°→+116°→+124°),然后又进行另一文氏周期。从肢体导联QRS电轴进行性右偏,结合每组最后一个QRS波呈典型左后分支阻滞波型(QRS_(Ⅰ、aVL)呈rS型、Ⅱ、Ⅲ、aVF呈qR型,电轴右偏+124°),说明左后分支内的化导逐渐延缓或受阻,提示直接显示性左后分支传导阻滞,文氏周期的传导比例为4:3～5:4。
Wen’s phenomenon can occur in any part of the heart conduction system, while the occurrence of Venn’s phenomenon in the branch is relatively rare. We encountered a case of direct display of the left posterior branch of the Venturi-type block, especially reported as follows. Electrocardiogram analysis The figure is recorded on November 24, 1981 angina pectoris electrocardiogram, showing sinus arrhythmia, PP spacing maximum mutual integration 0.13 seconds, the average heart rate 86 beats / min, PR interval was fixed 0.16 seconds, QRS time limit Constantly 0.08 seconds. The leads of limbs showed a regular change of QRS morphology with 4 or 5 heartbeats as a group. The first QRS of each joint started, the S wave of Ⅰ and aVL leads gradually, and the R wave of Ⅱ, Ⅲ and aVF leads Gradually increased, frontal QRS axis (Ⅱ, Ⅲ lead) gradually shifted from + 82 ° to + 124 ° (+ 82 ° → + 116 ° → + 124 °), and then another Wen’s period. From the QRS axis of the limb lead to the right deviation, combined with the last QRS wave of each group showed a typical left posterior branch block wave pattern (QRS_ (Ⅰ, aVL) was rS type, Ⅱ, Ⅲ, aVF was qR type, the axis Right deviation +124 °), indicating that the guidance in the left posterior branch of the gradual delay or obstruction, suggesting that the direct display of the left posterior branch block, the cycle of Wen’s transmission ratio of 4: 3 ~ 5: 4.