Hemiblocks Revisited
The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and sc...
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| Published in | Circulation (New York, N.Y.) Vol. 115; no. 9; pp. 1154 - 1163 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
06.03.2007
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 1524-4539 |
| DOI | 10.1161/CIRCULATIONAHA.106.637389 |
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| Abstract | The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures. |
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| AbstractList | The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures. The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures. The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures.The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures. |
| Author | Elizari, Marcelo V. Ferreiro, Marcela Acunzo, Rafael S. |
| Author_xml | – sequence: 1 givenname: Marcelo V. surname: Elizari fullname: Elizari, Marcelo V. organization: From the Division of Cardiology, Ramos Mejía Hospital, Buenos Aires, Argentina – sequence: 2 givenname: Rafael S. surname: Acunzo fullname: Acunzo, Rafael S. organization: From the Division of Cardiology, Ramos Mejía Hospital, Buenos Aires, Argentina – sequence: 3 givenname: Marcela surname: Ferreiro fullname: Ferreiro, Marcela organization: From the Division of Cardiology, Ramos Mejía Hospital, Buenos Aires, Argentina |
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| Keywords | Myocardial infarction bundle-branch block Arrhythmia Heart disease Heart block Cardiovascular disease Bundle branch block Myocardial disease Conduction disorder Epidemiology heart septal defects |
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| References_xml | – ident: e_1_3_2_25_2 doi: 10.1161/circ.52.1.1132124 – ident: e_1_3_2_27_2 doi: 10.1016/S0033-0620(64)80020-7 – ident: e_1_3_2_9_2 doi: 10.1016/S0022-0736(78)80028-4 – ident: e_1_3_2_30_2 doi: 10.1016/0002-8703(78)90205-3 – ident: e_1_3_2_1_2 – volume: 63 start-page: 292 year: 1992 ident: e_1_3_2_36_2 publication-title: Aviat Space Environ Med – ident: e_1_3_2_4_2 doi: 10.1142/9781860943812 – volume: 47 start-page: 562 year: 1972 ident: e_1_3_2_10_2 publication-title: Mayo Clin Proc – ident: e_1_3_2_38_2 – ident: e_1_3_2_5_2 doi: 10.1136/hrt.34.8.807 – ident: e_1_3_2_28_2 doi: 10.1016/0002-9149(78)90316-8 – ident: e_1_3_2_6_2 – ident: e_1_3_2_18_2 doi: 10.1378/chest.60.6.543 – ident: e_1_3_2_21_2 doi: 10.1161/circ.42.5.895 – ident: e_1_3_2_13_2 doi: 10.1016/0002-9149(72)90002-1 – ident: e_1_3_2_3_2 doi: 10.1016/0002-9149(79)90025-0 – ident: e_1_3_2_22_2 doi: 10.1016/0002-9149(70)90752-6 – ident: e_1_3_2_17_2 doi: 10.1378/chest.60.4.362 – ident: e_1_3_2_12_2 doi: 10.1378/chest.58.4.342 – ident: e_1_3_2_34_2 – ident: e_1_3_2_42_2 doi: 10.1016/0002-9149(67)90002-1 – ident: e_1_3_2_41_2 doi: 10.1016/0002-9149(79)90020-1 – ident: e_1_3_2_31_2 – ident: e_1_3_2_11_2 doi: 10.1161/circ.47.1.8 – volume: 59 start-page: 651 year: 1988 ident: e_1_3_2_37_2 publication-title: Aviat Space Environ Med – volume: 54 start-page: 27 year: 1971 ident: e_1_3_2_43_2 publication-title: Trans Assoc Life Ins Med Dir Am – start-page: 7 year: 1972 ident: e_1_3_2_19_2 publication-title: Am J Card – ident: e_1_3_2_23_2 doi: 10.1161/circ.46.3.587 – ident: e_1_3_2_35_2 doi: 10.1016/0002-9149(75)90116-2 – ident: e_1_3_2_29_2 doi: 10.7326/0003-4819-75-1-23 – ident: e_1_3_2_44_2 doi: 10.1016/j.jacc.2005.05.059 – volume: 58 start-page: 298 year: 1973 ident: e_1_3_2_20_2 publication-title: Circulation – ident: e_1_3_2_32_2 doi: 10.1161/circulationaha.106.174287 – ident: e_1_3_2_7_2 doi: 10.1067/mhj.2002.125503 – ident: e_1_3_2_33_2 – ident: e_1_3_2_45_2 doi: 10.1136/hrt.37.7.711 – volume: 21 start-page: 242 year: 1978 ident: e_1_3_2_8_2 publication-title: Adv Cardiol – ident: e_1_3_2_14_2 doi: 10.1016/0002-9149(72)90529-2 – ident: e_1_3_2_40_2 doi: 10.1056/NEJM197302082880603 – volume: 64 start-page: 165 year: 1996 ident: e_1_3_2_26_2 publication-title: Rev Argent Cardiol – ident: e_1_3_2_24_2 doi: 10.1161/circ.51.6.1132092 – ident: e_1_3_2_2_2 – ident: e_1_3_2_15_2 doi: 10.1136/hrt.36.7.660 – volume: 6 start-page: 403 year: 1978 ident: e_1_3_2_16_2 publication-title: Eur J Cardiol – ident: e_1_3_2_39_2 doi: 10.1016/0002-9149(72)90002-1 – ident: e_1_3_2_46_2 doi: 10.1016/0002-9149(75)90075-2 |
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| Snippet | The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his... |
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| SubjectTerms | Adams-Stokes Syndrome - etiology Adolescent Adult Aged Biological and medical sciences Blood and lymphatic vessels Bundle-Branch Block - complications Bundle-Branch Block - diagnosis Bundle-Branch Block - physiopathology Cardiology. Vascular system Diagnostic Errors Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Female Heart Block - classification Heart Block - complications Heart Block - diagnosis Heart Block - epidemiology Heart Block - physiopathology Heart Conduction System - anatomy & histology Heart Conduction System - physiopathology Humans Hypertrophy, Left Ventricular - complications Hypertrophy, Left Ventricular - diagnosis Male Medical sciences Middle Aged Myocardial Infarction - complications Myocardial Infarction - diagnosis Prevalence Prognosis Retrospective Studies Vectorcardiography |
| Title | Hemiblocks Revisited |
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