["Left bundle branch block" pattern induced by premature right atrial stimulation. Electrogenetic and clinical considerations (author's transl)]. 1981

A Raviele, and E Piccolo, and P Delise, and D Caberlotto, and F Di Pede, and E Callegari

Although in the last years very important knowledges have been obtained in the field of the intraventricular conduction disturbances, many electrocardiographic-vectorcardiographic findings concerning the left bundle branch block (LBBB) and their electrogenesis are still controversial. With the purpose to clarify this problem we have reviewed and analysed 23 cases in whom BCG-VCG patterns of "complete" or "incomplete" LBBB were induced by the premature right atrial stimulation (PRAS) during an electrophysiologic study in man. The analysis of these cases have demonstrated that: 1) the same LBBB pattern can be caused by a slowed conduction or block at different sites of left intraventricular conduction system i.e. not only in the main stem of the left bundle branch (LBB) (tronkular LBBB) but also within the bundle of His (intra-His LBBB) or in all the three fascicles of the LBB distally to its subdivision (divisional LBBB); 2) ECG-VCG are not able to distinguish the anatomical or functional site of slowed conduction or block; 3) the right or left axis deviation in the LBBB is not due to LBBB per se but it represents or a block at two different sites, i.e. a tronkular or intra His LBBB plus a block in the anterior or posterior subdivision of the LBB, or a block at only one side i.e. a tronkular, intra-His or divisional LBBB but with prevalent involvement of one fascicle of the LBB; 4) the ECG-VCG "incomplete" LBBB pattern is similar to that of the left ventricular enlargement; 5) figures of "atypical LBBB" are not specific of myocardial necrosis; 6) the criteria for the diagnosis of "complete" LBBB are not reliable. We conclude that, since LBBB pattern does not always correspond to a slowed conduction or block in the main stem of the LBB, the current terminology of LBBB is inappropriate and could be changed with another which considers the site of delayed activation and not the site of slowed conduction. Therefore we propose the following terminology: 1) generalized left ventricular activation delay instead of LBBB without axis deviation; 2) generalized left ventricular activation delay superiorly predominant instead of LBBB with left axis deviation; 3) generalized left ventricular activation delay inferiorly predominant instead of LBBB with right axis deviation.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009206 Myocardium The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow. Muscle, Cardiac,Muscle, Heart,Cardiac Muscle,Myocardia,Cardiac Muscles,Heart Muscle,Heart Muscles,Muscles, Cardiac,Muscles, Heart
D009336 Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
D002037 Bundle-Branch Block A form of heart block in which the electrical stimulation of HEART VENTRICLES is interrupted at either one of the branches of BUNDLE OF HIS thus preventing the simultaneous depolarization of the two ventricles. Fascicular Block,Anterior Fascicular Block,Bundle Branch Block,Left Bundle-Branch Block,Posterior Fascicular Block,Right Bundle-Branch Block,Anterior Fascicular Blocks,Block, Anterior Fascicular,Block, Bundle Branch,Block, Bundle-Branch,Block, Fascicular,Block, Left Bundle-Branch,Block, Posterior Fascicular,Block, Right Bundle-Branch,Blocks, Anterior Fascicular,Blocks, Bundle Branch,Blocks, Bundle-Branch,Blocks, Fascicular,Blocks, Left Bundle-Branch,Blocks, Posterior Fascicular,Blocks, Right Bundle-Branch,Branch Block, Bundle,Branch Blocks, Bundle,Bundle Branch Blocks,Bundle-Branch Block, Left,Bundle-Branch Block, Right,Bundle-Branch Blocks,Bundle-Branch Blocks, Left,Bundle-Branch Blocks, Right,Fascicular Block, Anterior,Fascicular Block, Posterior,Fascicular Blocks,Fascicular Blocks, Anterior,Fascicular Blocks, Posterior,Left Bundle Branch Block,Left Bundle-Branch Blocks,Posterior Fascicular Blocks,Right Bundle Branch Block,Right Bundle-Branch Blocks
D004558 Electric Stimulation Use of electric potential or currents to elicit biological responses. Stimulation, Electric,Electrical Stimulation,Electric Stimulations,Electrical Stimulations,Stimulation, Electrical,Stimulations, Electric,Stimulations, Electrical
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D005260 Female Females
D006325 Heart Atria The chambers of the heart, to which the BLOOD returns from the circulation. Heart Atrium,Left Atrium,Right Atrium,Atria, Heart,Atrium, Heart,Atrium, Left,Atrium, Right
D006329 Heart Conduction System An impulse-conducting system composed of modified cardiac muscle, having the power of spontaneous rhythmicity and conduction more highly developed than the rest of the heart. Conduction System, Heart,Conduction Systems, Heart,Heart Conduction Systems,System, Heart Conduction,Systems, Heart Conduction

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