Further Observations on the Etiology of the Right Bundle Branch Block Pattern Following Right Ventriculotomy

Krongrad, Ehud; Hefler, Stephen E.; Bowman, Frederick O.; Malm, James R.; Hoffman, Brian F.

doi:10.1161/01.cir.50.6.1105

Cited by 63 publications

(12 citation statements)

References 21 publications

(4 reference statements)

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“…RBBB has been considered a benign condition without any negative impact on the long-term prognosis; it appears that this concept must be Pediatr Cardiol 20:326-330, 1999 Pediatric Cardiology revised to some extent, considering that a very wide QRS complex has been recognized as a risk factor for malignant ventricular arrhythmias [20]. RBBB may be due to interruption of the bundle centrally during closure of the VSD; however, often it is caused by the right ventricular incision (so-called distal RBBB) [26,32]. The site of the block can be determined by endocardial electrophysiologic recordings [15,42].…”

Section: Conduction Disturbancesmentioning

confidence: 99%

Electrophysiological Follow-Up of Tetralogy of Fallot

Friedli

1999

Pediatr Cardiol

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Arrhythmias and sudden death are well-recognized complications that occur late after correction of tetralogy of Fallot. This study, based on the literature and personal work, reviews the numerous investigations prompted by these complications and provides recommendations regarding follow-up. Conduction disturbances and ventricular arrhythmias are both common; although mostly asymptomatic, they are the likely cause of syncopy and sudden death. Supraventricular arrhythmias are less common but cause symptoms more frequently. Detecting patients at risk for life-threatening arrhythmias is an important task. The simple surface electrocardiogram (ECG) gives a host of information regarding patients at risk. Holter recordings, signal-averaged ECG, and invasive electrophysiological studies may all be helpful; the indications to perform these investigations are discussed and propositions are made for the follow-up of the postoperative patient. There is hope that a systematic approach along these lines, together with surgery done at an earlier age, will decrease the incidence of severe arrhythmias and sudden death in the future.

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Section: Conduction Disturbancesmentioning

confidence: 99%

Electrophysiological Follow-Up of Tetralogy of Fallot

Friedli

1999

Pediatr Cardiol

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“…The clinical observations of Gelband et al (2) and Krongrad et al (14) have suggested that the electrocardiographic pattern of right bundle branch block developed immediately after the right ventriculotomy incision. Because there was no associated injury to the ventricular septum with this incision, thereby excluding the possibility of central injury to the right bundle branch, the authors deduced that there was "peripheral" injury to the right bundle branch.…”

Section: Discussionmentioning

confidence: 99%

“…Because there was no associated injury to the ventricular septum with this incision, thereby excluding the possibility of central injury to the right bundle branch, the authors deduced that there was "peripheral" injury to the right bundle branch. Krongrad et al (14) suggested that the conduction defect was distal to the insertion of the terminal fascicles of the right bundle into the ventricular myocardium. The prognostic significance of "peripheral" right bundle branch block would thus be excellent because conduction through the proximal right bundle branch and its terminal fascicles would be normal.…”

Section: Discussionmentioning

confidence: 99%

Experimental Right Ventriculotomy: Effects on Local Propagation at a Small Size Scale

Moak

Garson

1988

Pediatr Res

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ABSTRAm. Repair of tetralogy of Fallot and ventricular septal defect frequently requires righ ventriculotomy. Although the mechanisms for right bundle branch block (RBBB) have been frequently discussed, the pathogenesis of this electrocardiographic abnormality is still unknown. To determine if disruption of the distal subendocardial Purkinje fiber network in the right ventricular free wall produced RBBB and if cellular electrophysiologic abnormalities in or near the ventriculotomy scar could provide a substrate for conductance disturbances, we investigated the electrocardiographic and electrophysiologic effects of experimental right ventriculotomy in 12 beagles. On the surface electrocardiogram no significant differences in QRS duration (lead 11) or morphology were apparent between the control group (n = 6) and the postventriculotomy animals (n = 6) (QRS duration = 34 f 4 versus 34 f 7

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“…13 In others, proximal interruption occurred when septal sutures were placed to close the interventricular septal defect,5' 1' and in still others, following isolated pulmonary infundibular resection. "3' 2 In short, the right bundle branch may be injured along its entire course when open heart surgery is carried out in its proximity.…”

mentioning

confidence: 99%

“…However, the identification of the precise location of injury is more complex in cases in which several procedures that may cause a right bundle branch block were carried out, such as in patients with tetralogy of Fallot who had a right ventriculotomy and ventricular septal defect closure and infundibular resection. In such patients injury to the right bundle branch may occur as an isolated or combined lesion with each of the surgical procedures.8 13 The effect of the surgically created right bundle branch block pattern on long-term prognosis is unknown. It can be assumed reasonably that prognosis is related to the location of injury.…”

mentioning

confidence: 99%

Prognosis for patients with congenital heart disease and postoperative intraventricular conduction defects.

Krongrad¹

1978

Circulation

113

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Intraventricular conduction defects are common following repair of various forms of congenital heart disease. Such defects may affect adversely the long-term prognosis of patients in whom cardiac hemodynamics were adequately restored. Review of previously published studies suggests that the site of the conduction defect may be the reason for the different prognoses reported for patients from different institutions. The so-called "trifascicular block" pattern which sometimes occurs following open heart surgery is probably due to a more extensive lesion to the branching and penetrating parts of the His bundle rather than additional injury to the posterior left bundle branch fibers. Transient complete heart block in the immediate postoperative period seems to be a predictor for late development of complete heart block or sudden death at least as powerful as right bundle branch block and left anterior hemiblock.

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Further Observations on the Etiology of the Right Bundle Branch Block Pattern Following Right Ventriculotomy

Cited by 63 publications

References 21 publications

Electrophysiological Follow-Up of Tetralogy of Fallot

Electrophysiological Follow-Up of Tetralogy of Fallot

Experimental Right Ventriculotomy: Effects on Local Propagation at a Small Size Scale

Prognosis for patients with congenital heart disease and postoperative intraventricular conduction defects.

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