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The history of left septal fascicular block: chronological considerations of a reality yet to be universally accepted.

Riera AR, Uchida AH, Schapachnik E, Dubner S, Zhang L, Filho CF, Ferreira C, Ferrara DE, de Luna AB, Moffa PJ - Indian Pacing Electrophysiol J (2008)

Bottom Line: There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases) splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF), left posterior fascicle (LPF), and left septal fascicle (LSF).The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation.Additionally, the mentioned papers have been performed both in animal models (dogs) and in the human heart.Several clinical papers have shown that the left septal fascicular block (LSFB) may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs.The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF), which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others.In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder.In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin America, Chagas disease.

View Article: PubMed Central - PubMed

Affiliation: Electro-Vectorcardigraphic Section, ABC Medical School, ABC Foundation, Santo Andre - Sao Paulo, Brazil. riera@uol.com.br

ABSTRACT
There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases) splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF), left posterior fascicle (LPF), and left septal fascicle (LSF). The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation.Additionally, the mentioned papers have been performed both in animal models (dogs) and in the human heart.Several clinical papers have shown that the left septal fascicular block (LSFB) may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs.The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF), which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others. In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder.In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin America, Chagas disease.

No MeSH data available.


Related in: MedlinePlus

Sequence of 10ms Initial Normal Ventricular Activation
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Figure 2: Sequence of 10ms Initial Normal Ventricular Activation

Mentions: In 1970, Dr. Dirk Durrer et al [18] from the Departments of Cardiology and Physiology, Amsterdam, established in a classical manuscript, using 870 intramural terminals in the isolated human heart that three endocardial areas were synchronously excited from 0 to 5 ms after the start of the left ventricle (LV) activity potential. To obtain information concerning the time course and instantaneous distribution of the normal excitatory process, the authors studied isolated hearts from seven individuals who died from cerebral conditions but had no history of cardiac disease (Figure 2).


The history of left septal fascicular block: chronological considerations of a reality yet to be universally accepted.

Riera AR, Uchida AH, Schapachnik E, Dubner S, Zhang L, Filho CF, Ferreira C, Ferrara DE, de Luna AB, Moffa PJ - Indian Pacing Electrophysiol J (2008)

Sequence of 10ms Initial Normal Ventricular Activation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267895&req=5

Figure 2: Sequence of 10ms Initial Normal Ventricular Activation
Mentions: In 1970, Dr. Dirk Durrer et al [18] from the Departments of Cardiology and Physiology, Amsterdam, established in a classical manuscript, using 870 intramural terminals in the isolated human heart that three endocardial areas were synchronously excited from 0 to 5 ms after the start of the left ventricle (LV) activity potential. To obtain information concerning the time course and instantaneous distribution of the normal excitatory process, the authors studied isolated hearts from seven individuals who died from cerebral conditions but had no history of cardiac disease (Figure 2).

Bottom Line: There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases) splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF), left posterior fascicle (LPF), and left septal fascicle (LSF).The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation.Additionally, the mentioned papers have been performed both in animal models (dogs) and in the human heart.Several clinical papers have shown that the left septal fascicular block (LSFB) may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs.The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF), which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others.In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder.In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin America, Chagas disease.

View Article: PubMed Central - PubMed

Affiliation: Electro-Vectorcardigraphic Section, ABC Medical School, ABC Foundation, Santo Andre - Sao Paulo, Brazil. riera@uol.com.br

ABSTRACT
There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases) splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF), left posterior fascicle (LPF), and left septal fascicle (LSF). The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation.Additionally, the mentioned papers have been performed both in animal models (dogs) and in the human heart.Several clinical papers have shown that the left septal fascicular block (LSFB) may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs.The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF), which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others. In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder.In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin America, Chagas disease.

No MeSH data available.


Related in: MedlinePlus