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October 9, 1972, Vol 222, No. 2 >
ARTICLE | October 9, 1972

ECG Patterns Useful in the Diagnosis of Intermittent Heart Block FREE

Jacob I. Haft, MD; Richard P. Lasser, MD
[+] Author Affiliations

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JAMA. 1972;222(2):184-188. doi:10.1001/jama.1972.03210020034008
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References

Blockages in any of the three intraventricular conduction pathways (the right bundle branch, and anterior superior radiations and posterior inferior radiations of the left bundle branch) have specific effects on the QRS pattern as seen on the standard electrocardiogram. The presence of block in two of the three pathways (manifested by right bundle branch block and left axis deviation, right bundle branch block and right axis deviation, alternating complete right and left bundle branch block, or to a lesser extent left bundle branch block) has been found in many patients with documented intermittent heart block or in patients who subsequently develop permanent complete heart block. The presence of this QRS pattern in patients with histories of syncope or dizziness suggests that their symptoms may be due to intermittent heart block. Such patients should be monitored to document heart block, or should have permanent demand pacemakers implanted, or both.

REFERENCES

1 +
Damato AN, Lau SH, Helfant RH, et al:  Study of atrioventricular conduction in man using electrode catheter recording of His bundle activity . Circulation 39:287-296, 1969;.
2 +
Narula OS, Samet P:  Wenckebach and Mobitz Type II A-V block due to block within the His bundle and bundle branches . Circulation 41:947-965, 1970;.
3 +
Haft JI, Weinstock M, DeGuia R:  Electrophysiological studies in Mobitz Type II second degree heart block . Amer J Cardiol 27:682-686, 1971;.
4 +
Rosen KM, Loeb HS, Chuquimia R, et al:  Site of heart block in acute myocardial infarction . Circulation 42:925-933, 1970;.
5 +
Steiner C, Lau SH, Stein E, et al:  Electrophysiological documentation of bilateral bundle branch block as the common cause of complete heart block , abstracted. Ann Intern Med 72:778, 1970;.
6 +
Haft JI, Weinstock M, Gupta P, et al:  Localization of conduction defects in patients with complete heart block using His bundle recordings , abstracted. Clin Res 18:310, 1970;.
7 +
Narula OS, Scherlag BJ, Javier RP, et al:  Analysis of A-V conduction defect in complete heart block utilizing His bundle electrograms . Circulation 41:437-442, 1970;.
8 +
Lenegre J:  Etiology and pathology of bilateral bundle branch block in relation to complete heart block . Progr Cardiovasc Dis 6:409-444, 1964;.
9 +
Watt TB, Murao S, Pruitt RD:  Left axis deviation induced experimentally in a primate heart . Amer Heart J 70:381-389, 1965;.
10 +
Rosenbaum MB:  Types of left bundle branch block and their clinical significance . J Electrocardiol 2:197-206, 1969;.
11 +
Lasser RP, Haft JI, Friedberg CK:  Heart block associated with right bundle branch block and marked left axis deviation . Clin Res 14:255, 1966;.
12 +
Lasser RP, Haft JI, Friedberg CK:  Relationship of right bundle branch block and marked left axis deviation (with left parietal or periinfarction block) to complete heart block and syncope . Circulation 37:429-437, 1968;.
13 +
Lepeshkin E:  Electrocardiographic diagnosis of bilateral bundle branch block in relation to heart block . Progr Cardiovasc Dis 6:445, 1964;.
14 +
Saltzman P, Linn H, Pick A:  Right bundle branch block with left axis deviation . Brit Heart J 28:203-208, 1966;.
15 +
Watt TB, Pruitt RD:  Character, cause and consequence of combined left axis deviation and right bundle branch block in the human electrocardiogram . Amer Heart J 77:460-465, 1969;.
16 +
Kulburtus H, Collignon P:  Association of right bundle branch block with left superior or inferior intraventricular block, its relation to complete heart block and Stokes-Adams syndrome . Brit Heart J 31:435-440, 1970;.
17 +
Castellanos A, Maytin D, Arcesal AG, et al:  Significance of complete right bundle branch block with right axis deviation in absence of right ventricular hypertrophy . Brit Heart J 32:85-92, 1970;.
18 +
Rosenbaum MB, Elizari MV, Lazzari JO: The Hemiblocks . Oldsmar, Fla, Tampa Tracings, 1970;, pp 146-147.
19 +
Harris A, Bluestone R, Busby E, et al:  The management of heart block . Brit Heart J 27:469, 1965;.
20 +
Schloff LD, Adler L, Donoso E, et al:  Bilateral bundle branch block: Clinical and electrocardiographic aspects . Circulation 35:790, 1967;.

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1 +
Damato AN, Lau SH, Helfant RH, et al:  Study of atrioventricular conduction in man using electrode catheter recording of His bundle activity . Circulation 39:287-296, 1969;.
2 +
Narula OS, Samet P:  Wenckebach and Mobitz Type II A-V block due to block within the His bundle and bundle branches . Circulation 41:947-965, 1970;.
3 +
Haft JI, Weinstock M, DeGuia R:  Electrophysiological studies in Mobitz Type II second degree heart block . Amer J Cardiol 27:682-686, 1971;.
4 +
Rosen KM, Loeb HS, Chuquimia R, et al:  Site of heart block in acute myocardial infarction . Circulation 42:925-933, 1970;.
5 +
Steiner C, Lau SH, Stein E, et al:  Electrophysiological documentation of bilateral bundle branch block as the common cause of complete heart block , abstracted. Ann Intern Med 72:778, 1970;.
6 +
Haft JI, Weinstock M, Gupta P, et al:  Localization of conduction defects in patients with complete heart block using His bundle recordings , abstracted. Clin Res 18:310, 1970;.
7 +
Narula OS, Scherlag BJ, Javier RP, et al:  Analysis of A-V conduction defect in complete heart block utilizing His bundle electrograms . Circulation 41:437-442, 1970;.
8 +
Lenegre J:  Etiology and pathology of bilateral bundle branch block in relation to complete heart block . Progr Cardiovasc Dis 6:409-444, 1964;.
9 +
Watt TB, Murao S, Pruitt RD:  Left axis deviation induced experimentally in a primate heart . Amer Heart J 70:381-389, 1965;.
10 +
Rosenbaum MB:  Types of left bundle branch block and their clinical significance . J Electrocardiol 2:197-206, 1969;.
11 +
Lasser RP, Haft JI, Friedberg CK:  Heart block associated with right bundle branch block and marked left axis deviation . Clin Res 14:255, 1966;.
12 +
Lasser RP, Haft JI, Friedberg CK:  Relationship of right bundle branch block and marked left axis deviation (with left parietal or periinfarction block) to complete heart block and syncope . Circulation 37:429-437, 1968;.
13 +
Lepeshkin E:  Electrocardiographic diagnosis of bilateral bundle branch block in relation to heart block . Progr Cardiovasc Dis 6:445, 1964;.
14 +
Saltzman P, Linn H, Pick A:  Right bundle branch block with left axis deviation . Brit Heart J 28:203-208, 1966;.
15 +
Watt TB, Pruitt RD:  Character, cause and consequence of combined left axis deviation and right bundle branch block in the human electrocardiogram . Amer Heart J 77:460-465, 1969;.
16 +
Kulburtus H, Collignon P:  Association of right bundle branch block with left superior or inferior intraventricular block, its relation to complete heart block and Stokes-Adams syndrome . Brit Heart J 31:435-440, 1970;.
17 +
Castellanos A, Maytin D, Arcesal AG, et al:  Significance of complete right bundle branch block with right axis deviation in absence of right ventricular hypertrophy . Brit Heart J 32:85-92, 1970;.
18 +
Rosenbaum MB, Elizari MV, Lazzari JO: The Hemiblocks . Oldsmar, Fla, Tampa Tracings, 1970;, pp 146-147.
19 +
Harris A, Bluestone R, Busby E, et al:  The management of heart block . Brit Heart J 27:469, 1965;.
20 +
Schloff LD, Adler L, Donoso E, et al:  Bilateral bundle branch block: Clinical and electrocardiographic aspects . Circulation 35:790, 1967;.

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