The tetrafascicular nature of the intraventricular conduction system

Pérez‐Riera, Andrés Ricardo; Barbosa‐Barros, Raimundo; Daminello‐Raimundo, Rodrigo; Abreu, Luíz Carlos de; Nikus, Kjell

doi:10.1002/clc.23093

Cited by 13 publications

(5 citation statements)

References 30 publications

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“…In this type, the LSF may originate from the main LBB or its division (PD or AD). In type II, the LSF branches concomitantly from AD and PD, whereas in type III, it appears as a "fan-like interconnecting network" (Figure 2) (11,(26)(27)(28). The existence and importance of LSF cannot be ignored.…”

Section: Anatomy Of the Lbbmentioning

confidence: 99%

“…The existence and importance of LSF cannot be ignored. Particularly, these fibers are known to produce a network of interwoven strands that cover the inferior third of the septum, which avoids the widening of QRS when one of the divisions of the LBB is blocked ( 26 , 28 , 29 ). Overall, LBB's anatomical characteristics determine the feasibility of LBBP as a potential physiological pacing modality.…”

Section: Anatomy Of the Lbbmentioning

confidence: 99%

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Left Bundle Branch Pacing: Current Knowledge and Future Prospects

Liu

Wang

Sun

et al. 2021

Front. Cardiovasc. Med.

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Cardiac pacing is an effective therapy for treating patients with bradycardia due to sinus node dysfunction or atrioventricular block. However, traditional right ventricular apical pacing (RVAP) causes electric and mechanical dyssynchrony, which is associated with increased risk for atrial arrhythmias and heart failure. Therefore, there is a need to develop a physiological pacing approach that activates the normal cardiac conduction and provides synchronized contraction of ventricles. Although His bundle pacing (HBP) has been widely used as a physiological pacing modality, it is limited by challenging implantation technique, unsatisfactory success rate in patients with wide QRS wave, high pacing capture threshold, and early battery depletion. Recently, the left bundle branch pacing (LBBP), defined as the capture of left bundle branch (LBB) via transventricular septal approach, has emerged as a newly physiological pacing modality. Results from early clinical studies have demonstrated LBBP's feasibility and safety, with rare complications and high success rate. Overall, this approach has been found to provide physiological pacing that guarantees electrical synchrony of the left ventricle with low pacing threshold. This was previously specifically characterized by narrow paced QRS duration, large R waves, fast synchronized left ventricular activation, and correction of left bundle branch block. Therefore, LBBP may be a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or biventricular pacing (BVP). However, the technique's widespread adaptation needs further validation to ascertain its safety and efficacy in randomized clinical trials. In this review, we discuss the current knowledge of LBBP.

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Section: Anatomy Of the Lbbmentioning

confidence: 99%

Section: Anatomy Of the Lbbmentioning

confidence: 99%

Left Bundle Branch Pacing: Current Knowledge and Future Prospects

Liu

Wang

Sun

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

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“…2A-C and the third, fourth, and fifth beats of Fig. 2D is the transient manifestation of PAF secondary to an LSFB (18,19). Transient PAF in the horizontal plane meets the criteria for LSFB, although the QRS duration reached 0.12 seconds in the fourth beats in Figs.…”

Section: Discussionmentioning

confidence: 87%

Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves

et al. 2021

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In a patient with variant angina of the proximal left anterior descending coronary artery, myocardial ischemia changed the QRS-ST-T configurations without J-waves into those resembling "lambda" waves at maximal ST-segment elevation, and couplets or triplets of supraventricular extrasystole (SVE) changed the ischemia-induced "lambda" waves into QRS-ST-T configurations resembling a "tombstone" morphology or "monophasic QRS-ST complex." At the resolution phase of coronary spasm, the QRS-ST-T configurations returned to those without J-waves and were changed by SVE into "lambda" waves. Interestingly, neither ischemia-nor SVE-induced "lambda" waves or SVE-induced "tombstone" morphology or "monophasic QRS-ST complex" were complicated by ventricular tachyarrhythmia.

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“…Differences in LV scar size were driven by a higher prevalence of non-ischemic pattern scar. Interestingly, there was no increase in prevalence of scarring in the basal anteroseptal and anterior segments of the LV, which are those segments where the left anterior fascicle has its course (16,17). It thus seems unlikely that focal non-ischemic scarring or infarction detectable by LGE CMR along the course of the left anterior fascicle is the primary etiology of LAFB.…”

Section: Scar Size Etiology and Locationmentioning

confidence: 99%

Left anterior fascicular block is associated with non-ischemic myocardial scar and proportionately decreased ejection fraction

Scheele

Atwater

Klem

et al. 2022

Preprint

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Background: Left anterior fascicular block (LAFB) has been associated with increased mortality, but the underlying causes are unknown. We hypothesized that LAFB is associated with increased left ventricular (LV) scar burden and reduced LV ejection fraction (LVEF). Methods: Patients referred for cardiovascular magnetic resonance imaging (CMR) and electrocardiography (ECG) were retrospectively enrolled. Patients with LAFB (n=51) and matched control patients without LAFB (n=600) were compared regarding size and location of LV scar, LVEF, and a dysfunction index describing the difference between measured LVEF and expected LVEF where the expected LVEF is based on scar size. Results: Compared to matched controls, patients with LAFB had on average a larger LV scar (median [interquartile range] 0.7 [0.0-6.6] vs 0.0 [0.0-1.5] % LV mass, p<0.001). LAFB was associated with a higher prevalence of any scar (59% vs 33%, p<0.001). Patients with LAFB had similar prevalence of ischemic scar (29% vs 23%, p=0.40) but a higher prevalence of non-ischemic scar (29% vs 10%, p=0.001) which was most frequently located in the basal and mid inferoseptal segments and the anterior and lateral apical LV segments. LVEF was lower in patients with LAFB than matched controls (58 [43-60] vs 60 [55-60] %, p=0.02), but there was no difference in dysfunction index (24.0 [17.8-25.5] vs 24.0 [19.0-27.8] %-points of LVEF, p=0.32) Conclusions: In a matched hospital cohort, LAFB was associated with a small decrease in LVEF that was proportionate to the increased LV scar burden. This increased LV scar burden was more commonly due to non-ischemic etiology and not infarction, and not more commonly located near the expected course of the left anterior fascicle.

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The tetrafascicular nature of the intraventricular conduction system

Cited by 13 publications

References 30 publications

Left Bundle Branch Pacing: Current Knowledge and Future Prospects

Left Bundle Branch Pacing: Current Knowledge and Future Prospects

Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves

Left anterior fascicular block is associated with non-ischemic myocardial scar and proportionately decreased ejection fraction

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