不完全性右束支合并左前分支阻滞患者与单纯左前分支阻滞患者在器质性心脏病中的临床意义

The clinic significance and prognosis of IRBBB+LAFB and LAFB in organic heart disease

目的探讨不完全性右束支传导阻滞（IRBBB）合并左前分支传导阻滞（LAFB）的临床意义。方法选取解放军总医院2009年~2013年间心电图表现为不完全性右束支合并左前分支阻滞的患者为试验组,选取同期受检的器质性心脏病合并左前分支阻滞患者按照性别、年龄及临床疾病进行1：4配对为对照组。通过（4.0±1.5）年的随访观察,根据临床资料和终点事件来评价双支阻滞的预后情况。终点事件定义为不良心血管事件（MACEs）,包括心绞痛症状加重、心律失常、非致死性心肌梗死、安装起搏器、再血管化治疗以及死亡。结果两组比较,IRBBB＋LAFB组患者预后与器质性心脏病LAFB组患者在多个终点事件发生率上比较,差异无统计学意义（P〉0.05）,且冠状动脉疾病是IRBBB＋LAFB最常见的原因,占52.6%,此类双分支阻滞还常见于高血压性心脏病、先天性心脏病、主动脉瓣病变、心肌病等其他器质性疾病。结论 IRBBB＋LAFB患者病死率和病情进展程度与原发的基础疾病有关,临床预后情况也和完全性右束支合并左前分支不同。

Objective To investigate the prognosis of patients with incomplete right bundle branch block（IRBBB）complicated with left anterior fascicular block（LAFB）. Methods The test group consisted of patients with cardiogram manifestations of IRBBB ＋ LAFB,who were treated at the General Hospital of Chinese PLA between 2008 and 2013. Patients with organic heart disease（OHD） and LAFB were matched at a ratio of 1：4 by gender,age,and clinical diseases. Via 4.0 ± 1.5 years of follow-up,the prognosis of bifascicular block was assessed according to clinical data and endpoint events. Endpoint events were recorded and defined as major adverse cardiac events（MACEs）,including chest pain,arrhythmia,non-fatal myocardial infarction,plantation of pacemaker or scaffold,and death. Results In comparison between IRBBB ＋ LAFB and LAFB,the prognosis outcomes were not significantly different between the IRBBB ＋ LAFB patients and the LAFB ＋ OHD patients in several endpoints（P〉0.05）. Moreover,coronary disease was a common cause of IRBBB ＋ LAFB（52.6%）. Such bifascicular block is also commonly concurrent with other organic diseases,such as hypertensive heart disease,congenital heart disease,aortic valvular disease,and cardiomyopathy. The mortality rate and disease progression degree of IRBBB ＋ LAFB are associated with primary basic diseases. Conclusion The clinical prognosis is also different from the CRBBB complicated with LAFB.