Association between left bundle branch block and anterosuperior hemiblock
Revisiting evidences
Keywords:
Bundle-Branch Block, Electrocardiography, VectorcardiographyAbstract
The concomitant diagnosis of left bundle branch block and anterosuperior hemi-block is controversial among cardiologists, especially when there is left vectorcardiographic axis deviation. In a brief literature review, we describe His bundle’s anatomy and its trifascicular nature, we present Medrano’s quadrifascicular theory and revise the
diagnostic criteria of these two electrocardiographic entities. We conclude that concomitant block might be found in cases of post-divisional bifascicular blocks with greater involvement of the anterosuperior hemiblock. On the other hand, the cardiologist must keep in mind that there are other causes of left axis deviation in the presence of left bundle branch block, such as: inferior infarction, anterior-septal and lateral infarction, and atypical bypass tracts.
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References
1. Rosenbaum M, Elizari M, Lázzari J, eds. Los hemibloqueos. Buenos Aires, Argentina: Paidos; 1968. p. 112-28.
2. Tawara S. Das Reizleitungssystem des Saügetierherzens. Jena, Alemanha: Gustav Fischer; 1906. p. 34-114.
3. Hudson RE. Surgical pathology of the conducting system of the heart. Br Heart J. 1967;29:646-70.
4. Elizari MV. The normal variants in the left bundle branch system. J Electrocardiol. 2017;50(4):389-99.
5. James TN, Sherf L. Fine structure of the His bundle. Circulation. 1971; 44(1):9-28.
6. Narula OS. Longitudinal dissociation in the His bundle. Bundle branch block due to asynchronous conduction within the His bundle in man. Circulation. 1977;56(6):996-1006.
7. El-Sherif N, Amay-Y-Leon F, Schonfield C, Scherlag BJ, Rosen K, Lazzara R, et al. Normalization of bundle branch block patterns by distal His bundle pacing. Clinical and experimental evidence of longitudinal dissociation in the pathologic His bundle. Circulation. 1978;57(3):473-83.
8. Scherlag BJ, Lazzara R. Functional aspects of His bundle physiology and pathophysiology: Clinical implications. J Electrocardiol. 2017; 50(1):151-5.
9. Sharma PS, Dandamudi G, Naperkowski A, Oren JW, Storm RH, Ellenbogen KA, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm. 2015;12(2):305-12.
10. Medrano GA, Brenes C, de Micheli A, Sodi-Pallares D. [Simultaneous block of the anterior and posterior subdivisions of the left branch of the bundle of His (biphasic block), and its association with the right branch block (triphasic block). Experimental and clinical electrocardiographic study]. Arch Inst Cardiol Mex. 1970;40(6):752-70.
11. Pérez Riera AR, Ferreira C, Ferreira Filho C, Meneghini A, Uchida AH, Moffa PJ, et al. Electrovectorcardiographic
diagnosis of left septal fascicular block: anatomic and clinical considerations. Ann Noninvasive Electrocardiol. 2011;16(2):196-207.
12. Bayés de Luna A, Riera AP, Baranchuk A, Chiale P, Iturralde P, Pastore C, et al. Electrocardiographic manifestation of the middle fibers/septal fascicle block: a consensus report. J Electrocardiol. 2012;45(5):454-60.
13. Rosenbaum MB. Types of left bundle branch block and their clinical significance. J Electrocardiol. 1969;2(2):197-206.
14. de Luna AB, ed. Clinical Electrocardiography: A Textbook. 4a ed. Oxford, Reino Unido: Wiley-Blackwell; 2010. p. 158-202.
15. Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107(6):927-34.
16. Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC. Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Am Heart J. 2012;163(2):260-7.
17. Sternick EB, Gerken LM. The 12-lead ECG in patients with Mahaim fibers. Ann Noninvasive Electrocardiol. 2006;1191):63-83.
18. de Micheli A, Medrano GA, Aranda A. [Non-complicated and complicated polyfascicular blocks]. Arch Cardiol Mex. 2002;72(3):240-8.
19. Medrano GA, de Micheli A, Iturralde P. Peripheral heart blocks associated with myocardial infarcts: clinical diagnosis based on experimental findings. Curr Cardiol Rev. 2008;4(2):140-7.
2. Tawara S. Das Reizleitungssystem des Saügetierherzens. Jena, Alemanha: Gustav Fischer; 1906. p. 34-114.
3. Hudson RE. Surgical pathology of the conducting system of the heart. Br Heart J. 1967;29:646-70.
4. Elizari MV. The normal variants in the left bundle branch system. J Electrocardiol. 2017;50(4):389-99.
5. James TN, Sherf L. Fine structure of the His bundle. Circulation. 1971; 44(1):9-28.
6. Narula OS. Longitudinal dissociation in the His bundle. Bundle branch block due to asynchronous conduction within the His bundle in man. Circulation. 1977;56(6):996-1006.
7. El-Sherif N, Amay-Y-Leon F, Schonfield C, Scherlag BJ, Rosen K, Lazzara R, et al. Normalization of bundle branch block patterns by distal His bundle pacing. Clinical and experimental evidence of longitudinal dissociation in the pathologic His bundle. Circulation. 1978;57(3):473-83.
8. Scherlag BJ, Lazzara R. Functional aspects of His bundle physiology and pathophysiology: Clinical implications. J Electrocardiol. 2017; 50(1):151-5.
9. Sharma PS, Dandamudi G, Naperkowski A, Oren JW, Storm RH, Ellenbogen KA, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm. 2015;12(2):305-12.
10. Medrano GA, Brenes C, de Micheli A, Sodi-Pallares D. [Simultaneous block of the anterior and posterior subdivisions of the left branch of the bundle of His (biphasic block), and its association with the right branch block (triphasic block). Experimental and clinical electrocardiographic study]. Arch Inst Cardiol Mex. 1970;40(6):752-70.
11. Pérez Riera AR, Ferreira C, Ferreira Filho C, Meneghini A, Uchida AH, Moffa PJ, et al. Electrovectorcardiographic
diagnosis of left septal fascicular block: anatomic and clinical considerations. Ann Noninvasive Electrocardiol. 2011;16(2):196-207.
12. Bayés de Luna A, Riera AP, Baranchuk A, Chiale P, Iturralde P, Pastore C, et al. Electrocardiographic manifestation of the middle fibers/septal fascicle block: a consensus report. J Electrocardiol. 2012;45(5):454-60.
13. Rosenbaum MB. Types of left bundle branch block and their clinical significance. J Electrocardiol. 1969;2(2):197-206.
14. de Luna AB, ed. Clinical Electrocardiography: A Textbook. 4a ed. Oxford, Reino Unido: Wiley-Blackwell; 2010. p. 158-202.
15. Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107(6):927-34.
16. Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC. Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Am Heart J. 2012;163(2):260-7.
17. Sternick EB, Gerken LM. The 12-lead ECG in patients with Mahaim fibers. Ann Noninvasive Electrocardiol. 2006;1191):63-83.
18. de Micheli A, Medrano GA, Aranda A. [Non-complicated and complicated polyfascicular blocks]. Arch Cardiol Mex. 2002;72(3):240-8.
19. Medrano GA, de Micheli A, Iturralde P. Peripheral heart blocks associated with myocardial infarcts: clinical diagnosis based on experimental findings. Curr Cardiol Rev. 2008;4(2):140-7.
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Published
2018-01-08
How to Cite
Nunes de Alencar Neto, J. (2018). Association between left bundle branch block and anterosuperior hemiblock: Revisiting evidences. JOURNAL OF CARDIAC ARRHYTHMIAS, 31(1), 8–12. Retrieved from https://jca.org.br/jca/article/view/45
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Review Article
