Document Detail

Quantitative effects of functional bundle branch block in patients with atrioventricular reentrant tachycardia.
MedLine Citation:
PMID:  10758921     Owner:  NLM     Status:  MEDLINE    
Changes in the retrograde conduction time (ventriculoatrial [VA]) interval during functional bundle branch block (BBB) have been used to separate septal from free wall accessory pathways (APs), but different values of the VA interval prolongation (deltaVA) have been described in different reports. A total of 95 patients with single nondecremental APs who developed BBB during atrioventricular reentrant tachycardia were studied. Free wall APs were found in 60 patients, and 35 had septal APs. For patients with free wall APs, complete and incomplete BBB ipsilateral to the atrial insertion site of APs were observed in 39 of 60 patients (65%) and 31 of 60 patients (52%), respectively. For patients who had both complete (QRS > or = 120 ms) and incomplete (QRS <120 ms) BBB during atrioventricular reentrant tachycardia, deltaVA for patients with complete BBB was significantly greater than in those with incomplete BBB, 59 +/- 19 ms versus 30 +/- 11 ms, p <0.001. For patients with septal APs and complete and incomplete BBB during tachycardia, the mean deltaVA for those with complete BBB was 31 +/- 20 ms and was significantly longer than in patients with incomplete BBB (14 +/- 6 ms), p <0.001. There was no significant difference in deltaVA between those with free wall APs and incomplete BBB compared with those with septal APs and complete BBB. The criteria of QRS > or = 120 ms associated with deltaVA > or =40 ms served to best separate free wall from septal APs with a sensitivity of 88% and a specificity of 89%. Left anterior fascicular block was associated with marked lengthening of deltaVA for those with left free wall APs, whereas a left posterior fascicular block pattern resulted in a marked increase in the deltaVA for patients with posteroseptal APs. In the absence of fascicular block patterns, a deltaVA > or =40 ms provides strong evidence of a free wall AP, with a sensitivity of 95% and a specificity of 100%. The left posterior fascicle appears to provide predominant innervation of the posterior septum.
Y Yang; J Cheng; K Glatter; P Dorostkar; G W Modin; M M Scheinman
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  85     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-04-21     Completed Date:  2000-04-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  826-31     Citation Subset:  AIM; IM    
Cardiovascular Research Institute, University of California San Francisco, 94143, USA.
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MeSH Terms
Bundle of His / abnormalities,  physiopathology,  surgery
Bundle-Branch Block / complications,  physiopathology*,  surgery
Catheter Ablation
Child, Preschool
Heart Rate
Middle Aged
Retrospective Studies
Tachycardia, Atrioventricular Nodal Reentry / complications,  diagnosis,  physiopathology*,  surgery
Treatment Outcome

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