Document Detail


Alternating right and left bundle branch block aberration during atrial tachycardia.
MedLine Citation:
PMID:  19376525     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In a patient with atrial tachycardia with a rate of 200 per minute, the A-V conduction ratio was at times 2:1, but often it was 4:3 or 3:2 with progressive P-R interval prolongation (Wenckebach mechanism, an expression of presumable A-V nodal block). In each episode of 4:3 conduction, the first QRS complex was narrow, and the 2 ensuing beats were wide due to aberrant conduction. Aberration did not occur with a constant configuration, but in consecutive episodes of 4:3 conduction ratio there was a regular alternation of left bundle branch block and right bundle branch block. The pattern was explained by concealed retrograde conduction into the anterogradely blocked bundle branch. This caused 2 distinct effects: (1) shifting "to the right" of the refractory period of the affected bundle branch, resulting in maintenance of aberration with the same configuration, if consecutive atrial impulses were conducted to the ventricles, and (2) shortening of the effective cycle of the affected bundle branch, resulting in aberration due to block of the controlateral bundle branch, whenever a pause occasioned by a nonconducted atrial impulse was followed by restoration of 1:1 conduction for 2 or more consecutive beats.
Authors:
Maria Pia Calabr??; Marco Cerrito; Francesco Luzza; Giuseppe Oreto
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-04-18
Journal Detail:
Title:  Journal of electrocardiology     Volume:  42     ISSN:  1532-8430     ISO Abbreviation:  J Electrocardiol     Publication Date:    2009 Nov-Dec
Date Detail:
Created Date:  2009-10-26     Completed Date:  2010-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  633-5     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, University of Messina, Via Terranova 9, Messina, Italy.
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / complications*,  diagnosis*
Bundle-Branch Block / classification,  complications*,  diagnosis*
Diagnosis, Differential
Electrocardiography / methods*
Female
Humans
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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