[Clinical types of trifascicular block and a follow-up study of pacemaker application]

Thirty five patients (pts) with trifascicular block (TFB) were followed up for 5 years, and indication of pacemaker and clinical types of TFB were discussed. All of the 35 pts were diagnosed with clinical, ECG monitoring and His bundle electrogram (HBE) and classified into 4 groups: (1) acute transient TFB (3 cases) characterized by RBBB + LAHB + I or II AVB, caused by acute myocarditis or AMI, recovered with medicinal treatment; (2) 4 cases of acute advanced TFB characterized by RBBB + LAHB or LAPB + III AVB with severe symptoms such as syncope and Adams-Stokes syndrome; (3) 12 cases of chronic TFB characterized by RBBB + LAHB or LPHB + I, II or III AVB, with 40 beats/min lower heart rate and severe symptoms; (4) 18 cases of chronic advanced TFB characterized by RBBB + LAHB or LPHB + 1, 11 or III AVB, with severe symptoms. The 32 pts in groups 2, 3, and 4 were treated with implanted pacemakers and recovered very well. 29 pts are still well with pacemakers, and 5 cases with cardiomyopathy died due to chronic heart failure during the follow-up period of 5 years.

all of the pts with TFB and severe symptoms treated with pacemakers were appropriate, and are living well except those with chronic heart failure.