右束支阻滞的早期表现,迄今未被描述,作者发现首先是V_2的S波变浅。随着右束支阻滞的进展,V_2的S波上升支出现粗钝或切迹,随后出现r′波。更进一步发展时,r′波逐渐增高,发展到完全性右束支阻滞时,V_2形成典型的高而宽、平顶或端有切迹的R′波。上述变化的主要机理是,正常心室激动开始是从室间隔的左侧至右侧,表现为V_1的初始r波与V_6的初始q波。随后,间隔旁区从心内膜到心外膜除极(圈1中2a和2b),形成V_2的初始r波。最后,左、右心室游离璧从内向外除极(图1中3a和3b),形成从右向左的综合向量,表 The early manifestation of right bundle branch block has not been described so far. The authors found that the S-waves of V 2 are first of all shallowed. With the progress of the right bundle branch block, the rising of S wave of V_2 appears blunt or notch, then the r ’wave appears. Further development, r ’wave gradually increased, to the development of complete right bundle branch block, V 2 to form a typical high and wide, flat top or end notch R’ wave. The main mechanism of the above changes is that the normal ventricular activation starts from the left to the right of the interventricular septum and manifests as the initial r-wave of V_1 and the initial q-wave of V_6. Subsequently, the interventricular septum forms the initial r-wave of V_2 from the endocardium to the epicardial depolarization (2a and 2b in circle 1). Finally, the right and left ventricular free biodegradable electrodes (3a and 3b in Fig. 1) form an integrated vector from right to left,