Electrical, endocardial mapping of 5 patients with typical ECG of left middle fascicular block

Sanches, Paulo Cesar R.; Moffa, Paulo Jorge; Sosa, E; Scanavacca, Maurício; Vila, Amparo Marquina; Tobias, Nancy Maria Martins de Oliveira; Pastore, Carlos Alberto

doi:10.1054/jelc.2001.0340323

Cited by 6 publications

(1 citation statement)

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“…In Brazil, a committee of experts in Resting Electrocardiology met in 2003 and developed the “Brazilian Guidelines for Interpretation of Resting Electrocardiogram.” In this consensus, the diagnostic criteria of LSFB were determined and published 35 . However, it is important to remember different terminologies used in the literature: (1) left septal fascicular block (LSFB) 36–38,13,39–42 . This is the currently accepted terminology and frequently used in more recent publications; (2) septal fascicle of the left bundle branch 43 ; (3) focal septal block 22 ; septal focal block 21 ; (4) left parietal septal block 44,45 ; (5) septal fascicular conduction disorders of the left branch 46 ; (6) left septal Purkinje network block 47,48 ; (7) left anterior septal block 49 ; (8) anterior fascicular block 50 ; (9) left septal subdivision block of the left bundle branch 31,51,52 ; (10) left median hemiblock 53;54 ; (11) middle subdivision block of the left bundle branch 55 ; (12) middle fascicle block 17 ; (13) block of the antero‐medial division of the left bundle branch of His 15 ; (14) anteromedial divisional block (AMDB) 12 ; (15) block of the anterior median branch of the bundle of His; (16) blocking of the anterior‐medial Ramulus 56 ; (17) anterior conduction delay 29,31,52 and ( 18) intraventricular aberrant conduction 26,57 …”

Section: Nomenclature Used In Literaturementioning

confidence: 99%

Electrovectorcardiographic Diagnosis of Left Septal Fascicular Block: Anatomic and Clinical Considerations

Pérez‐Riera¹,

Ferreira²,

Meneghini³

et al. 2011

Noninvasive Electrocardiol

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Several publications considering anatomical, histological, pathological, electrocardiographic, vectorcardiographic, and electrophysiologic studies have shown that the left bundle branch splits into three fascicles or in a "fan-like interconnected network" in the vast majority of human hearts. The left His system is trifascicular with a left anterior, a left posterior, and a left septal fascicle (LSF). Consequently, the classic term "hemiblock," to describe the block of one of the fascicles, established several decades ago by the Rosembaum's school, should be updated. Electrovectorcardiographic changes resulting from conduction abnormalities of the left anterior and left posterior fascicles are commonly diagnosed, mainly by their changes in the frontal plane. However, the existence of conduction defects of the LSF remains controversial. The ECG/VCG hallmark of LSF block is prominent anterior QRS forces (PAF) on the horizontal plane. This ECG/VCG phenomena should be distinguished from other conditions that also produce anterior QRS shift in the HP as: normal variants, right ventricular enlargement, misplaced precordial leads, lateral myocardial infarction, right bundle branch block, Wolff-Parkinson-White, obstructive and nonobstructive forms of hypertrophic cardiomyopahty, diastolic left ventricular enlargement, endomiocardial fibrosis, Duchenne muscular dystrophy, and dextroposition. The two highly frequent etiologies of LSFB are ischemia (coronary artery disease (CAD) with critical proximal obstruction of the left anterior descending coronary artery) and, in Latin America, Chagas' cardiomyopathy. The aims of this review are to revise the evidence of the existence of a trifascicular left Hissian system and to help in the ECG/VCG recognition of the LSFB.

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