The electrocardiographic diagnosis of bilateral bundle branch block in relation to heart block

Lepeschkin, E.

doi:10.1016/s0033-0620(64)80002-5

Cited by 143 publications

(25 citation statements)

References 62 publications

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“…Based on the present state of knowledge, this finding is an indication that the V-A conduction traveled through the His bundle and A-V node before reaching the atria. In contrast, the V-A conduction following stimulation of the right ventricle 2 In the present case, there was evidence of permanent block of the right bundle branch and, therefore, A-V conduction was necessarily through the left bundle branch and the anomalous bundle. The observation during recording of His potentials of simultaneous block of alternate P waves both in the left bundle branch and in the pre-excitation pathway suggests that the two structures stayed together as far down as the level of block and were thus influenced to the same extent by factors causing failure of conduction.…”

Section: Discussioncontrasting

confidence: 67%

His Bundle Recordings in Bilateral Bundle-Branch Block Combined with Wolff-Parkinson-White Syndrome

Massumi

1970

Circulation

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SUMMARYAn example of bilateral bundle-branch block (RBBB) in the presence of WPW syndrome in which diagnosis was established with the aid of His bundle recordings is presented. Complete RBBB and intermittent block of the superior and inferior divisions of the left bundle branch were coexistent for at least 2 years before complete heart block (trifascicular block) occurred. It was demonstrated that the preexcitation pathway conducted and blocked together with the normal pathways. It is suggested that the anomalous bundle in this case traveled with the normal pathways and that this close relationship is more common than has been suspected.Retrograde V-A conduction at 1:1 ratio was present during electrical stimulation of the right ventricle and the anomalous bundle was used for retrograde spread of activation from the ventricles to the atria. The retrograde P waves, thus produced, conducted antegrade through the His bundle (reciprocation) but reached the ventricles only when they appeared near the end of the T waves of the preceding beats. The mechanism of supramaximal conductivity or excitability, therefore, appears to be a plausible explanation. Additional Indexing

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Section: Discussioncontrasting

confidence: 67%

His Bundle Recordings in Bilateral Bundle-Branch Block Combined with Wolff-Parkinson-White Syndrome

Massumi

1970

Circulation

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“…Bilateral bundle-branch block is a commonly observed conduction disturbance especially in the elderly, and the electrocardiographic patterns associated with it have been well established (Rosenbaum and Lepeschkin, 1955;Lenegre, 1964;Lepeschkin, 1964;Schloff et al, 1967;Langendorf and Pick, 1968;Rosenbaum, 1968;Watt and Pruitt, 1969;Rosenbaum et al, 1969;Rosenbaum, 1970;Scanlon et al, 1970;New York Heart Association Criteria Committee, 1973). Electrophysiological studies (His bundle recordings) have confirmed the most common site of atrioventricular block to be in the proximal His-Purkinje system (infranodal) (Damato et al, 1969;Schuilenburg and Durrer, 1970;Rosen et al, 1972;Spurrell Received for publication 19 July 197619 July et al, 1972Kunstad et al, 1973).…”

mentioning

confidence: 99%

Chronic bilateral bundle-branch block. Long-term observations in ambulatory patients.

Lister¹,

Kline²,

Lesser³

1977

Heart

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During a period of 28 months, all patients (79) who presented with bilateral bundle-branch block were selected for study from a private practice outpatient population. They were followed prospectively from the date of entry into the study and their charts were reviewed retrospectively. The average age of the participants was 73-3 years and they were observed clinically for a cumulative period of 4237 months (353-08 years). A high incidence of severe heart disease and death was noted among the study group. Twenty-four (30-3%) had a New York Heart Association functional classification of 3 or 4. Eight (10-1%) died. Only one patient died suddenly and he had had a stable electrocardiographic pattern of bilateral bundle-branch block for a period of 118 months (9 years 10 months). Seven patients required permanent pacemakers. In 6 instances death resulted from pump failure; in one it was the result of lung cancer. In none of these 7 individuals did rhythm disturbances contribute to death. In most cases vertigo was not of cardiac origin (88-2%). Eight patients had 11 major surgical procedures with no significant cardiac sequelae. Our observations suggest that elderly patients with chronic bilateral bundle-branch block should be managed conservatively. The prognosis in these patients appears primarily to be related to the degree of myocardial disease rather than to the conduction disorder.

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“…Most of the patients with bundle-branch fibrosis are elderly as are the patients in our series with blocks distal to the BH. On the other hand, heart block due to A- The electrocardiographic criteria12' [20][21][22] suggested previously cannot precisely localize the site of block during CHB and are not completely reliable, although they serve as rough guide lines. During complete heart block, if the QRS complex is normal (0.10 sec or less in duration), the block may be situated either in the A-V node or within the His bundle proximal to its bifurcation into bundle branches.…”

mentioning

confidence: 99%

Analysis of the A-V Conduction Defect in Complete Heart Block Utilizing His Bundle Electrograms

et al. 1970

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The electrocardiographic diagnosis of bilateral bundle branch block in relation to heart block

Cited by 143 publications

References 62 publications

His Bundle Recordings in Bilateral Bundle-Branch Block Combined with Wolff-Parkinson-White Syndrome

His Bundle Recordings in Bilateral Bundle-Branch Block Combined with Wolff-Parkinson-White Syndrome

Chronic bilateral bundle-branch block. Long-term observations in ambulatory patients.

Analysis of the A-V Conduction Defect in Complete Heart Block Utilizing His Bundle Electrograms

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