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中华心脏与心律电子杂志 ›› 2025, Vol. 13 ›› Issue (01) : 47 -53. doi: 10.3877/cma.j.issn.2095-6568.2025.01.005

综述

胸痛左束支阻滞综合征的研究进展
李霞玲1, 朱小刚1, 胡文泽1, 杨明1, 佟子川1,()   
  1. 1. 100032 北京,首都医科大学附属复兴医院心脏内科
  • 收稿日期:2024-05-24 出版日期:2025-03-25
  • 通信作者: 佟子川

Research progress of painful left bundle branch block syndrome

Xialing Li1, Xiaogang Zhu1, Wenze Hu1, Ming Yang1, Zichuan Tong1,()   

  1. 1. Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing 100032, China
  • Received:2024-05-24 Published:2025-03-25
  • Corresponding author: Zichuan Tong
引用本文:

李霞玲, 朱小刚, 胡文泽, 杨明, 佟子川. 胸痛左束支阻滞综合征的研究进展[J/OL]. 中华心脏与心律电子杂志, 2025, 13(01): 47-53.

Xialing Li, Xiaogang Zhu, Wenze Hu, Ming Yang, Zichuan Tong. Research progress of painful left bundle branch block syndrome[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2025, 13(01): 47-53.

胸痛左束支阻滞综合征的特征是在没有潜在心肌缺血的情况下,胸痛与快频率依赖的左束支阻滞同时出现及消失,病理生理机制可能与突发的心室不同步、冠状动脉微循环障碍及心脏内感受器过度敏感有关,治疗上运动及药物治疗效果不佳,近年传导系统起搏治疗进展较大。本文重点论述近年胸痛左束支阻滞综合征的研究进展。

图1 静息和轻微活动时的12导联心电图(1A为静息12导联心电图示窦性心律为60次/min,心电图未见异常;1B为轻微活动时,患者出现完全性左束支传导阻滞,QRS时限为140 ms,右心导联高T波(S/T=1.71),患者出现压榨样胸痛[12]
图2 典型左束支阻滞的心室电不同步(体表心电图标测分析心外膜室壁激动顺序,激动自右心室向左扩散,有2条慢传导线路:第1条从间隔底部向心尖方向,第2条仅限于前外侧前2/3区域;最晚左心室激动部位在外侧基底部[18] AP为前后位,LAO为左前斜肌,LL左侧位
图3 左束支阻滞(LBBB)的病理生理学(3A为收缩效率低下:上图显示LBBB和非缺血性心肌病患者室间隔和左心室侧壁的压力应变环,间隔做功为负功(蓝色区域),下图显示整个心室的分段做功分布;3B为间隔部低代谢:1例典型的LBBB和非缺血性心肌病患者的氟脱氧葡萄糖-正电子发射断层扫描(FDG-PET)左心室短轴和长轴图像,室间隔呈绿色(低强度)表示相对于左心室侧壁代谢较低;3C为间隔运动异常:室间隔射血前期缩短与相应的左心室侧壁延长相对应,当左心室侧壁开始缩短时,间隔有反弹伸展,收缩末期间隔缩短减少,右图为来自同一患者的胸骨旁M模式图像;3D为心尖摇摆:在等容收缩时,心尖被早期间隔和右心室游离壁收缩向右拉,而在收缩后期,心尖被晚期激动的左心室侧壁强力收缩拉回;E:二尖瓣反流:充血性心力衰竭合并LBBB患者的超声心动图,左图示严重二尖瓣反流,右图显心脏再同步治疗后二尖瓣反流明显减少[16])。
图4 PLBBBS诊断治疗流程图 LBBB为左束支传导阻滞,PLBBBS为胸痛左束支阻滞综合征,S/T为QRS波中S波与T波的振幅比值
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