Document Detail


Electrophysiological and clinical observations in patients with alternating bundle branch block.
MedLine Citation:
PMID:  1248077     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Electrophysiological studies (His bundle recordings and atrial stimulation) were performed in nine patients who manifested periods of both right and left bundle branch block (RBBB and LBBB). In seven of the patients, alternating bundle branch block appeared to reflect intermittent or chronic bundle branch block superimposed on incomplete (but electrocardiographically complete) block of the contralateral bundle branch. In three of these seven, shift from one bundle branch block pattern to the other was associated with reproducible change in H-V (mean change 30 msec), and could be induced by alteration of cardiac rate with carotid massage, coupled atrial stimulation, and rapid atrial pacing. In one of the seven, RBBB with a P-R of 0.20 seconds preceded chronic LBBB with a P-R of 0.24 seconds, implying that RBBB had been incomplete. In three of the seven, although a definite mechanism of alternation could not be demonstrated, transient contralateral bundle branch block occurred superimposed on chronic ipsilateral bundle branch block, implying that the ipsilateral block was incomplete. Two patients manifested periods of narrow QRS, LBBB, RBBB, and paroxysmal A-V block. Based upon pathological data (one case), this pattern appeared to reflect a lesion involving the distal His bundle and proximal bundle branches. In the total group of patients, clinical course was primarily determined by the severity of heart disease and not by occurrence of A-V block. The conduction defect in the majority of patients was surprisingly benign.
Authors:
D Wu; P Denes; R C Dhingra; F Amat-Y-Leon; C R Wyndham; R Chuquimia; K M Rosen
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  53     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1976 Mar 
Date Detail:
Created Date:  1976-04-30     Completed Date:  1976-04-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  456-64     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bundle of His / physiopathology
Bundle-Branch Block / diagnosis*,  physiopathology,  therapy
Electric Stimulation
Electrophysiology*
Female
Heart Rate
Humans
Male
Middle Aged
Pacemaker, Artificial
Recurrence

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


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