真假性左束支阻滞心电图的鉴别

Differential diagnosis of true and false left bundle branch block

左束支阻滞(left bundle branch block,LBBB)是不良心脏事件的独立预测因素,与不良预后密切相关。然而,心电图呈LBBB样并不意味着左束支传导功能完全阻断(真性LBBB),尚存在左束支传导延缓、室内阻滞等假性LBBB样图形(假性LBBB)。由于真假性LBBB的病理生理学、治疗方式及预后明显不同,因此准确鉴别二者尤为重要。本文总结了真假性LBBB的心电图特征、临床意义及如何识别真性LBBB。

Left bundle branch block(LBBB)is an independent predictor of adverse cardiac events and is closely associated with poor prognosis.However,the LBBB electrocardiogram(ECG)pattern does not necessarily imply complete conduction block of left bundle branch(true LBBB).False LBBB ECG patterns such as residual conduction of left bundle branch and intraventricular block still exist(false LBBB).Because the pathophysiology,treatment and prognosis of true and false LBBB are obviously different,it is especially important to make accurate differential diagnosis.This paper summarizes the ECG characteristics of true and false LBBB,their clinical significance,and how to identify true LBBB.