Transient and Persistent Atrial Standstill with His Bundle Lesions: Electrophysiologic and Pathologic Correlations
Transient and Persistent Atrial Standstill with His Bundle Lesions: Electrophysiologic and Pathologic Correlations
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短暂和持续性心房停搏及其束状病变：电生理和病理相关性
作者：
K. Rosen;S. Rahimtoola;R. Gunnar;M. Lev
对1例短暂性（TAS）和1例持续性心房静止（PAS）患者进行了电生理检查，包括希氏束记录和心房起搏（AP）。两人随后死亡，并获得了传导系统的连续切片的尸检。TAS患者出现左前支（LBB）阻滞，P-H间期为140 msec（正常，80-140 msec），H-Q为40 msec（正常，35-55 msec），AP阈值为1.2 ma。尸检显示窦房（SA）结动脉起飞近端的左回旋支完全闭塞，SA结小动脉硬化无梗死，左侧心脏骨骼硬化（LSCSS）破坏希氏束和LBB的穿透部分。PAS患者的心内记录显示无心房活动，H-Q为60 msec。心房在多个部位AP高达15 ma时不可兴奋。尸检发现以前未描述的心房疾病，其特征为小动脉硬化、纤维弹性组织增生、脂肪浸润和肌细胞空泡变性，仅中度SA和A-V结受累。存在LSCSS，破坏His束的分支部分。因此，TAS反映SA结缺血，无梗死; PAS反映新发心房退行性疾病; H-Q正常，希氏束穿透部分有病变，分支部分有类似病变，H-Q延长。
Electrophysiologic studies, including His bundle recording and atrial pacing (AP), were performed in one patient with transient (TAS) and another with persistent atrial standstill (PAS). Both subsequently expired, and postmortem examinations with serial sections of the conduction system were obtained. The patient with TAS had left bundle-branch (LBB) block, a P-H interval of 140 msec (normal, 80-140 msec), an H-Q of 40 msec (normal, 35-55 msec), and an AP threshold of 1.2 ma. Postmortem examination revealed total left circumflex occlusion proximal to the sinoatrial (SA) nodal artery takeoff, SA nodal arteriolosclerosis without infarction, and left-sided cardiac skeletal sclerosis (LSCSS) disrupting the penetrating portion of the His bundle and the LBB. Intracardiac recordings in the patient with PAS showed absent atrial activity and an H-Q of 60 msec. The atria were inexcitable with AP up to 15 ma at multiple sites. Postmortem examination revealed a previously undescribed atrial disease characterized by arteriolosclerosis, fibroelastosis, fatty infiltration, and vacuolar degeneration of muscle cells, with only moderate SA and A-V nodal involvement. LSCSS was present, disrupting the branching portion of the His bundle. Thus, TAS reflected SA nodal ischemia without infarction; PAS reflected a new atrial degenerative disease; H-Q was normal with a lesion in the penetrating portion of the His bundle and was prolonged with a similar lesion in the branching portion.