Etiology and pathology of bilateral bundle branch block in relation to complete heart block

Lenègre, J

doi:10.1016/s0033-0620(64)80001-3

Cited by 387 publications

(80 citation statements)

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“…calcification in the central fibrous body and a case in group 2 with calcific aortic stenosis. These findings are compatible with "idiopathic bundle branch fibrosis" or "fibrocalcific destruction of the conduction system," proposed by Lenegre,3 or "sclerosis of the left side of the cardiac skeleton," proposed by Lev.2…”

Section: Methodssupporting

confidence: 76%

“…STUDIES by Mahaim,' Lev,' Lenegre,3 Davies4 and others5-9 have contributed to our knowledge of complete atrioventricular (AV) block, and the development of His bundle electrocardiography has provided accurate techniques for the clinical evaluation of patients with AV block. '0 '7 According to the limited number of studies that have correlated electrophysiologic and histologic changes, patients with chronic complete AV block with wide QRS complexes and HV block by His bundle recordings have lesions of the bilateral bundle branches,'3 but patients with chronic complete AV block associated with narrow QRS complexes and AH block on His bundle recordings show a wide variety of anatomic lesions in the approaches to the AV node, in the AV node itself or in the common bundle.…”

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confidence: 99%

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Correlation of the width of the QRS complex with the pathologic anatomy of the cardiac conduction system in patients with chronic complete atrioventricular block.

Ohkawa¹,

Hackel²,

Re³

1981

Circulation

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SUMMARY A study correlating the electrocardiographic findings and the histology of the atrioventricular (AV) conduction system was carried out in 14 cases with chronic complete AV block and in 13 cases without chronic complete AV block. Patients with chronic complete AV block weredivided into two groups, based on the width of the QRS complex. The QRS complexes were narrow (< 0.12 second) in four cases (group 1) and wide (. 0.12 second) in 10 cases (group 2). In group 1, the main lesion was located in the penetrating portion of the His bundle (Hisp) in one heart, in the branching portion of the His bundle (Hisb) in another and in the combined regions of Hisb and the left bundle branch in two. Three of the four cases in group 1 had idiopathic fibrosis of the conduction system and one had calcific nodules in the central fibrous body. In group 2, the main lesion was located in Hisb in two cases, in the combined regions of Hisb and the right bundle branch in one, in the Hisb and in the bilateral bundle branches in two, and in the bilateral bundle branches in five. All cases in group 2 were of the idiopathic type, except case 5, which had calcific aortic stenosis.In 13 cases without chronic complete AV block the AV conduction system was histologically normal, except for slight-to-moderate aging changes in the His bundle or the bundle branches.Lesions of the Hisb, which is believed to be the "distal His" electrophysiologically, may induce complete AV block with narrow or wide QRS complexes, depending upon the severity of the lesions in Hisb or adjacent bundle branches.STUDIES by Mahaim,' Lev,' Lenegre tion system in consecutive patients with chronic complete AV block to clarify and reappraise the main sites of lesions in relation to the width of the QRS complexes in surface ECGs, and compare our findings with those in patients without chronic complete AV block.Materials and Methods We studied the hearts of 14 patients autopsied at Duke University from 1963-1978 in whom chronic complete AV block was diagnosed. (table 1). Cases with congenital complete AV block or surgically induced block were excluded. In addition, the hearts of 13 selected patients without chronic complete AV block who were of a similar average age were studied as controls (table 2). The hearts were examined by routine procedures that have been described,'8 including radiographic demonstration of the coronary arteries, which had been injected with a barium sulphate-gelatin mixture, followed by cross-sectioning of the coronary arteries at 5-mm intervals. The sinoatrial node was examined by making step sections of the crista terminalis region. The AV conducting tissue was studied using the method of Lev et al., ' and serial sections of the AV nodal tissue were mounted and stained on 35-mm plastic tape as previously described.20' 21 This permitted the examination of the AV node, penetrating and branching common bundles, and the proximal 2-3 cm of the left bundle and right bundle. The right bundle segment included most of the second intramuscular portion...

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Section: Methodssupporting

confidence: 76%

mentioning

confidence: 99%

Correlation of the width of the QRS complex with the pathologic anatomy of the cardiac conduction system in patients with chronic complete atrioventricular block.

Ohkawa¹,

Hackel²,

Re³

1981

Circulation

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“…(1) QRS duration is 0.15 sec, (2) mean QRS axis =-590, (3) there is a small, initial R wave of 0.04 sec in leads II and III, (4) in lead V1 there is an rsR' configuration, (5) intrinsicoid deflection in V6 is normal, and (6) marked clockwise rotat-on in precordial leads is present (a frequent finding). This was considered present when the ECG showed: (1) QRS duration of 0.12 sec or more; (2) mean electrical axis in standard leads more negative than -30°; (3) the presence of a small R wave of at least 0.04 sec in duration in leads II and III; (4) QRS configuration in V1 consisting of a notched R wave, or rR', or rSR', or rsr' complex; and (5) This was considered to be present when in addition to the above characteristics, abnormal Q waves were found in precordial leads or leads I and aVL or in all these leads.…”

Section: Electrocardiographic Criteriamentioning

confidence: 98%

Relationship of Right Bundle-Branch Block and Marked Left Axis Deviation (with Left Parietal or Peri-infarction Block) to Complete Heart Block and Syncope

1968

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“…27 Progression to complete heart block with a wide QRS escape rhythm can lead to syncope or sudden death. PCCD is an isolated conduction disorder, but some cases of dilated cardiomyopathy have been described in overlapping syndromes.…”

Section: Baruteau Et Al Inherited Isolated Heart Block In Childrenmentioning

confidence: 99%

Parental Electrocardiographic Screening Identifies a High Degree of Inheritance for Congenital and Childhood Nonimmune Isolated Atrioventricular Block

et al. 2012

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Background-The origin of congenital or childhood nonimmune isolated atrioventricular (AV) block remains unknown.We hypothesized that this conduction abnormality in the young may be a heritable disease. Methods and Results-A multicenter retrospective study (13 French referral centers, from 1980(13 French referral centers, from -2009 included 141 children with AV block diagnosed in utero, at birth, or before 15 years of age without structural heart abnormalities and without maternal antibodies. Parents and matched control subjects were investigated for family history and for ECG screening. In parents, a family history of sudden death or progressive cardiac conduction defect was found in 1.4% and 11.1%, respectively. Screening ECGs from 130 parents (mean age 42.0Ϯ6.8 years, 57 couples) were compared with those of 130 matched healthy control subjects. All parents were asymptomatic and in sinus rhythm, except for 1 with undetected complete AV block. Conduction abnormalities were more frequent in parents than in control subjects, found in 50.8% versus 4.6%, respectively (PϽ0.001). A long PR interval was found in 18.5% of the parents but never in control subjects (PϽ0.0001). Complete or incomplete right bundle-branch block was observed in 39.2% of the parents and 1.5% of the control subjects (PϽ0.0001). Complete or incomplete left bundle-branch block was found in 15.4% of the parents and 3.1% of the control subjects (PϽ0.0006). Estimated heritability for isolated conduction disturbances was 91% (95% confidence interval, 80%-100%). SCN5A mutation screening identified 2 mutations in 2 patients among 97 children. Conclusions-ECG screening in parents of children affected by idiopathic AV block revealed a high prevalence of conduction abnormalities. These results support the hypothesis of an inheritable trait in congenital and childhood nonimmune isolated AV block.

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Etiology and pathology of bilateral bundle branch block in relation to complete heart block

Cited by 387 publications

References 9 publications

Correlation of the width of the QRS complex with the pathologic anatomy of the cardiac conduction system in patients with chronic complete atrioventricular block.

Correlation of the width of the QRS complex with the pathologic anatomy of the cardiac conduction system in patients with chronic complete atrioventricular block.

Relationship of Right Bundle-Branch Block and Marked Left Axis Deviation (with Left Parietal or Peri-infarction Block) to Complete Heart Block and Syncope

Parental Electrocardiographic Screening Identifies a High Degree of Inheritance for Congenital and Childhood Nonimmune Isolated Atrioventricular Block

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