倒递减传导即严氏传导的心电图特征及其临床意义

李悦; 黄熹; 张余斌; 韩怡茹

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倒递减传导即严氏传导的心电图特征及其临床意义

特约专稿 | 更新时间：2026-04-28

- 倒递减传导即严氏传导的心电图特征及其临床意义
- Inverse Decremental Conduction—Yan Conduction and Its Electrocardiographic Characteristics and Clinical Significance
- 临床心电学杂志 2026年35卷第2期页码：109-116
- 作者机构：
  
  1.310003 浙江杭州，浙江大学医学院附属第一医院心电图室（李悦，黄熹，张余斌）
  2.职工保健科（韩怡茹）
- 作者简介：
  
  李悦，主要从事心律失常分析与机制研究，对起搏心电图的分析与诊断有一定研究。
  [ "张余斌，医学硕士，浙江大学医学院附属第一医院心电图室，主管技师。擅长复杂心律失常心电图、起搏心电图的分析与诊断。中国医疗保健国际交流促进会心律与心电分会委员，全国医药技术市场协会心电信息学分会委员，中国生物医学工程学会中国心律学分会心脏人工智能学组委员，浙江省医学会心电生理与起搏分会无创心电学组委员兼秘书，浙江省数理医学学会心电诊断专业委员会青年委员会副主任青委。参与《Management of Cardiac Arrhythmias, Third Edition》在内多本学科专著的编写和翻译，以第一作者/通讯作者在包括：BMJ、Circulation、JAMA Internal Medicine、JACC: Clinical Electrophysiology在内的SCI期刊及中文核心期刊发表论文十余篇。" ]
- 基金信息：
- DOI：
  中图分类号： R541.7
- 收稿：2026-01-07，
  
  录用：2026-01-15，
  
  纸质出版：2026-04-28
- 稿件说明：
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李悦, 黄熹, 张余斌, 等. 倒递减传导即严氏传导的心电图特征及其临床意义[J]. 临床心电学杂志, 2026, 35(2): 109-116.

LI Yue,HUANG Xi,ZHANG Yubin,et al.Inverse Decremental Conduction—Yan Conduction and Its Electrocardiographic Characteristics and Clinical Significance[J].J Clin Electrocardiol,2026,35(02):109-116.
李悦, 黄熹, 张余斌, 等. 倒递减传导即严氏传导的心电图特征及其临床意义[J]. 临床心电学杂志, 2026, 35(2): 109-116. DOI：

LI Yue,HUANG Xi,ZHANG Yubin,et al.Inverse Decremental Conduction—Yan Conduction and Its Electrocardiographic Characteristics and Clinical Significance[J].J Clin Electrocardiol,2026,35(02):109-116. DOI：

摘要

希氏束-浦肯野纤维系统（希-浦系统）在发生损伤或处于病理状态时，可出现倒递减传导这一特殊心电现象，激动在希-浦系统损伤部位的传导速度，在一定频率范围内，与上游刺激频率呈正相关。目前，有关倒递减传导的病例报道主要见于经导管主动脉瓣置换（TAVR）手术和经导管室间隔缺损封堵手术，这可能与手术所致的直接机械刺激、水肿、炎症及局部血肿等因素损伤希-浦系统局部区域有关。本文将通过3个相关病例（其中有2个病例继发于TAVR手术后，另1个可能与希-浦系统的退行性或缺血性改变有关），系统地介绍这一心电现象的潜在机制、心电表现和临床意义。

Abstract

His-Purkinje system

damaged or in a pathological state

may exhibit a unique electrocardiographic phenomenon known as inverse decremental conduction (also referred to as Yan conduction): within a certain frequency range

the conduction velocity at the damaged site of His-Purkinje system shows a proportional correlation with the upstream stimulation frequency. To date

case reports of inverse decremental conduction have primarily been observed following transcatheter aortic valve replacement (TAVR) and transcatheter ventricular septal defect closure procedures. This association likely stems from surgical-induced factors such as direct mechanical stimulation

edema

inflammation

or localized hematoma damaging specific regions of His-Purkinje system. This paper systematically reviews the potential mechanisms

electrocardiographic manifestations

and clinical significance of inverse decremental conduction through three relevant cases (two secondary to TAVR and one potentially related to degenerative or ischemic changes in His-Purkinje system).

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references

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