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November 13, 1981, Vol 246, No. 19 >
ARTICLE | November 13, 1981

Chronic Bundle-Branch Block: Title and subTitle BreakClinical Significance and Management FREE

John H. McAnulty, MD; Shahbudin H. Rahimtoola, MB, FRCP
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Division of Cardiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97201 (Dr McAnulty).


JAMA. 1981;246(19):2202-2204. doi:10.1001/jama.1981.03320190060033
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References

IT HAS been of concern that bundle-branch block is a precursor of complete heart block. The concept of the distal conduction system being composed of three discrete pathways is one reason for this concern. The bundle branches connect the atrioventricular node to the ventricle. Although this distal conduction system is a syncytium, it can be divided into three major fascicles: the right bundle and the two portions of the left bundle, the anterior fascicle, and the posterior fascicle.

Block of one of these fascicles, unifascicular block, can be recognized as either right bundle-branch block, left anterior fascicular block (left-axis deviation of at least —30 degrees with initial R waves in leads II, III, aVf, and Q wave in lead I, aVl), or left posterior fascicular block (right axis deviation of +105 degrees or greater, with Q waves in II, III, aVf, and initial R waves in I,

REFERENCES

1 +
Rotman M, Triebwasser JH:  A clinical and follow-up study of right and left bundle branch block . Circulation 1975;;51:477-484.
2 +
Schneider JF, Thomas HE Jr, Kreger BE, et al:  Newly acquired left bundle branch block: The Framingham study . Ann Intern Med 1979;;90:303-310.
3 +
Schneider JF, Thomas HE Jr, Kreger BE, et al:  Newly acquired right bundle branch block: The Framingham study . Ann Intern Med 1980;; 92:37-44.
4 +
McAnulty JH, Kauffman S, Murphy E, et al:  Survival in patients with intraventricular conduction defects . Arch Intern Med 1978;;138:30-35.
5 +
McAnulty JH, Rahimtoola SH, Murphy ES, et al:  A prospective study of sudden death in 'high risk' bundle branch block . N Engl J Med 1978;;299:209-215.
6 +
Denes P, Dhingra RC, Wu D, et al:  Sudden death in patients with chronic bifascicular block . Arch Intern Med 1977;;137:1005-1010.
7 +
Scanlon PJ, Pryor R, Blount SG Jr:  Right bundle-branch block associated with left superior or inferior intraventricular block: Clinical setting, prognosis and relation to complete heart block . Circulation 1970;;42:1123-1133.
8 +
DePasquale NP, Bruno MS:  Natural history of combined right bundle branch block and left anterior hemiblock (bilateral bundle branch block) . Am J Med 1973;;54:297-303.
9 +
Vera Z, Mason DT, Fletcher RD, et al:  Prolonged His-Q interval in chronic bifascicular block: Relation to impending complete heart block . Circulation 1976;;53:46-55.
10 +
Scheinman M, Peters RW, Modin G, et al:  Prognostic value of infranodal conduction time in patients with chronic bundle branch block . Circulation 1977;;56:240-244.
11 +
Dhingra RC, Wyndham C, Amat-y-Leon F, et al:  Incidence and site of atrioventricular block in patients with chronic bifascicular block . Circulation 1979;;59:238-248.
12 +
Wyse DG, McAnulty JH, Rahimtoola SH, et al:  Electrophysiologic abnormalities of sinus node and atrium in patients with bundle branch block . Circulation 1979;;60:413-420.
13 +
McAnulty JH, Rahimtoola SH, Murphy ES, et al:  Final results of a large prospective study on chronic bundle branch block , abstracted. Clin Res 1981;;29:222.
14 +
Peters RW, Scheinman MM, Modin G, et al:  Prophylactic permanent pacemakers for patients with chronic bundle branch block . Am J Med 1979;;66:978-985.
15 +
Surawicz B:  Prognosis of patients with chronic bifascicular block . Circulation 1979;; 60:40-42.
16 +
Dhingra RC, Wyndham C, Bauernfeind R, et al:  Significance of chronic bifascicular block without apparent organic heart disease . Circulation 1979;;60:33-39.
17 +
Dhingra RC, Denes P, Wu D, et al:  Syncope in patients with chronic bifascicular block: Significance, causative mechanisms and clinical implications . Ann Intern Med 1974;;81:302-306.
18 +
Rosen K, Dhingra R, Wyndham C, et al:  Significance of H-V interval in 515 patients with chronic bifascicular block , abstracted. Am J Cardiol 1980;;45:4.
19 +
Scheinman MM, Weiss AN, Shafton E, et al:  Electrophysiologic effects of procainamide in patients with intraventricular conduction delay . Circulation 1974;;49:522-529.
20 +
Wyse DG, McAnulty JH, Rahimtoola SH:  Electrophysiologic effects of procainamide in patients with normal and prolonged sino-atrial conduction time . Am J Cardiol 1979;;43:619-626.
21 +
Josephson ME, Seides SF, Batsford WP, et al:  Electrophysiologic effects of intramuscular quinidine on the atrioventricular conduction system in man . Am Heart J 1974;;87:55-64.
22 +
Desai JM, Scheinman M, Peters RW, et al:  Electrophysiologic effects of disopyramide in patients with bundle branch block . Circulation 1979;;59:215-225.
23 +
Roos JC, Dunning AJ:  Effects of lidocaine on impulse formation and conduction defects in man . Am Heart J 1975;;89:686-691.
24 +
Pastore JO, Yurchak PM, Janis KM, et al:  The risk of advanced heart block in surgical patients with right bundle branch block and left axis deviation . Circulation 1978;;57:677-680.

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1 +
Rotman M, Triebwasser JH:  A clinical and follow-up study of right and left bundle branch block . Circulation 1975;;51:477-484.
2 +
Schneider JF, Thomas HE Jr, Kreger BE, et al:  Newly acquired left bundle branch block: The Framingham study . Ann Intern Med 1979;;90:303-310.
3 +
Schneider JF, Thomas HE Jr, Kreger BE, et al:  Newly acquired right bundle branch block: The Framingham study . Ann Intern Med 1980;; 92:37-44.
4 +
McAnulty JH, Kauffman S, Murphy E, et al:  Survival in patients with intraventricular conduction defects . Arch Intern Med 1978;;138:30-35.
5 +
McAnulty JH, Rahimtoola SH, Murphy ES, et al:  A prospective study of sudden death in 'high risk' bundle branch block . N Engl J Med 1978;;299:209-215.
6 +
Denes P, Dhingra RC, Wu D, et al:  Sudden death in patients with chronic bifascicular block . Arch Intern Med 1977;;137:1005-1010.
7 +
Scanlon PJ, Pryor R, Blount SG Jr:  Right bundle-branch block associated with left superior or inferior intraventricular block: Clinical setting, prognosis and relation to complete heart block . Circulation 1970;;42:1123-1133.
8 +
DePasquale NP, Bruno MS:  Natural history of combined right bundle branch block and left anterior hemiblock (bilateral bundle branch block) . Am J Med 1973;;54:297-303.
9 +
Vera Z, Mason DT, Fletcher RD, et al:  Prolonged His-Q interval in chronic bifascicular block: Relation to impending complete heart block . Circulation 1976;;53:46-55.
10 +
Scheinman M, Peters RW, Modin G, et al:  Prognostic value of infranodal conduction time in patients with chronic bundle branch block . Circulation 1977;;56:240-244.
11 +
Dhingra RC, Wyndham C, Amat-y-Leon F, et al:  Incidence and site of atrioventricular block in patients with chronic bifascicular block . Circulation 1979;;59:238-248.
12 +
Wyse DG, McAnulty JH, Rahimtoola SH, et al:  Electrophysiologic abnormalities of sinus node and atrium in patients with bundle branch block . Circulation 1979;;60:413-420.
13 +
McAnulty JH, Rahimtoola SH, Murphy ES, et al:  Final results of a large prospective study on chronic bundle branch block , abstracted. Clin Res 1981;;29:222.
14 +
Peters RW, Scheinman MM, Modin G, et al:  Prophylactic permanent pacemakers for patients with chronic bundle branch block . Am J Med 1979;;66:978-985.
15 +
Surawicz B:  Prognosis of patients with chronic bifascicular block . Circulation 1979;; 60:40-42.
16 +
Dhingra RC, Wyndham C, Bauernfeind R, et al:  Significance of chronic bifascicular block without apparent organic heart disease . Circulation 1979;;60:33-39.
17 +
Dhingra RC, Denes P, Wu D, et al:  Syncope in patients with chronic bifascicular block: Significance, causative mechanisms and clinical implications . Ann Intern Med 1974;;81:302-306.
18 +
Rosen K, Dhingra R, Wyndham C, et al:  Significance of H-V interval in 515 patients with chronic bifascicular block , abstracted. Am J Cardiol 1980;;45:4.
19 +
Scheinman MM, Weiss AN, Shafton E, et al:  Electrophysiologic effects of procainamide in patients with intraventricular conduction delay . Circulation 1974;;49:522-529.
20 +
Wyse DG, McAnulty JH, Rahimtoola SH:  Electrophysiologic effects of procainamide in patients with normal and prolonged sino-atrial conduction time . Am J Cardiol 1979;;43:619-626.
21 +
Josephson ME, Seides SF, Batsford WP, et al:  Electrophysiologic effects of intramuscular quinidine on the atrioventricular conduction system in man . Am Heart J 1974;;87:55-64.
22 +
Desai JM, Scheinman M, Peters RW, et al:  Electrophysiologic effects of disopyramide in patients with bundle branch block . Circulation 1979;;59:215-225.
23 +
Roos JC, Dunning AJ:  Effects of lidocaine on impulse formation and conduction defects in man . Am Heart J 1975;;89:686-691.
24 +
Pastore JO, Yurchak PM, Janis KM, et al:  The risk of advanced heart block in surgical patients with right bundle branch block and left axis deviation . Circulation 1978;;57:677-680.

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