Coronary angiographic assessment of left posterior hemiblock

Papa, Louis A.; Scariato, Albert; Gottlieb, Ronald H.; Duca, Peter R.; Kasparian, Hratch

doi:10.1016/s0022-0736(83)80009-0

Cited by 5 publications

(1 citation statement)

References 11 publications

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“…Many studies [5][6][7] indicate that ischemia due to proximal left anterior descending artery disease or right coronary artery disease can affect the left posterior fascicle. This finding supports the validity of the location of coronary artery disease yielding the substrate for left posterior Purkinje reentry, in which the successful ablation site was located at the posterior midseptal wall in these studies.…”

Section: Discussionmentioning

confidence: 99%

Coronary PCI revascularization novel treatment of bundle branch reentrant ventricular tachycardia

Marrakchi

Laroussi

Bennour

et al. 2019

Journal of Cardiology Cases

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Section: Discussionmentioning

confidence: 99%

Coronary PCI revascularization novel treatment of bundle branch reentrant ventricular tachycardia

Marrakchi

Laroussi

Bennour

et al. 2019

Journal of Cardiology Cases

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Right ventricular infarction: Unusual electrocardiographic and electrophysiological manifestations

Kriwisky

Ackerman

Mosseri

et al. 1987

Clinical Cardiology

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, 1976;Wartman and Hellerstein, 1948). This report describes a patient with isolated right ventricular infarction with unusual electrophysiological findings. Her initial electrocardiogram showed atrial escape rhythm with incomplete right bundle-branch block and left posterior hemiblock. Later, she developed atrioventricular (AV) block with supra-and infra-Hisian, "phase 4," conduction defects. The sinus malfunction and high degree AV block persisted over 2 weeks and an atrioventricular sequential pacemaker was implanted. Hymodynamic study showed that her cardiac output was highly dependent on the heart rate and properly timed AV interval, and the pacemaker was programmed accordingly. Case Report A 69-year-old female, without a previous history of heart disease was admitted because of sudden transient loss of consciousness. On physical examination, the blood pressure was 120/70 mmHg, the lungs were clear, and the neck veins distended. There were no abnormal heart sounds nor murmurs. The serum creatine kinase was 200 units with MB fraction of 15 % . Her initial electrocardiogram (Fig. 1) demonstrated sinus arrest with an atrial escape rhythm of 54 beatdmin, a QRS pattern of right bundle-branch block with left posterior hemiblock (RBBB+LPHB) and a QR pattern in V,, mild ST elevation in V,-4 and absence of Q wave in either V2.4 or aVL and L, or in the diaphragmatic leads. These findings are compatible with isolated right ventricular infarction. Within a few minutes, complete AV block developed with a ventricular escape rhythm of 40 beatdmin. Chest radiography showed mild cardiomegaly with clear lung fields. Echocardiography showed that the right ventricle was dilated and contracted poorly. There was no pericardial effusion. Similar findings were obtained using a technetium99m (99mTc) red cell labelled, multiple gated blood pool scan (MUGA) (Fig. 2). A Swan Ganz catheter was inserted and the following pressures were measured: right atrium, 10 mmHg with a "dip and plateau" pattern; pulmonary artery, 34/7 mmHg; wedge pressure, 7 mmHg. The cardiac index was 2.1 I/min per mz. These imaging and hemodynamic findings confirmed the intial diagnosis of acute right ventricular infarction. Isotonic fluids, plasma, and dextran were given intravenously. A temporary atrioventricular pacemaker was inserted transvenously and her condition improved. Seven days later, her atrioventricular conduction improved and 1 : 1 AV response to atrial pacing was observed. However, during repeated attempts to lower the atrial-paced rhythm below 50 beatdmin, complete AV block appeared. Gradual disappearance of the block followed an increase in the atrial pacing rate above 50 beatdmin. The RBBB + LPHB persisted.His bundle recording during high right atrial pacing (Table I) showed marked prolongation of the PA interval, the HV interval was also prolonged and the AH interval was at the upper limit of normal (Puech, 1975). The minimal

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Isolated left posterior fascicular block: A reliable marker for inferior myocardial infarction and associated severe coronary artery disease

Godat

Gertsch

1993

Clinical Cardiology

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The electrocardiographic (ECG) pattern of isolated left posterior fascicular block (LPFB) is a rare condition. It seems that true LPFB is often not recognized, whereas in cases of simple QRS axis of +60 degrees to +100 degrees in the frontal plane, the diagnosis of LPFB is made erroneously. Both facts rely on controversial and partially misleading opinions in the literature. Therefore, a retrospective and prospective study was performed in order to determine the prevalence of LPFB and to correlate its presence to the underlying disease. Retrospective study: Of a cohort of 830 patients referred in 1988 to a cardiologic laboratory for invasive investigation of certain or suspected coronary artery disease (CAD), 163 patients had an old inferior myocardial infarction (IMI). Nine patients (5.5%) showed the typical pattern of LPFB; eight of these had three-vessel disease. The diagnosis of IMI had been made only in one case before entry of the patient into the hospital, since LPFB generally masks IMI. Prospective study: 2502 ECGs were investigated, 1710 from a department of cardiology and 792 from two departments of internal medicine. Six LPFBs were detected (0.24%), all associated with IMI and four of them with three-vessel CAD. It is concluded that LPFB is a rare but clinically important intraventricular conduction disturbance. Its appearance is reliably connected with IMI and generally reflects severe three-vessel CAD, requiring invasive investigation.

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Coronary angiographic assessment of left posterior hemiblock

Cited by 5 publications

References 11 publications

Coronary PCI revascularization novel treatment of bundle branch reentrant ventricular tachycardia

Coronary PCI revascularization novel treatment of bundle branch reentrant ventricular tachycardia

Right ventricular infarction: Unusual electrocardiographic and electrophysiological manifestations

Isolated left posterior fascicular block: A reliable marker for inferior myocardial infarction and associated severe coronary artery disease

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