Conduction abnormality in the heart
Medical condition
Bifascicular block Two consecutive 12-lead ECGs recorded one minute apart on a symptomatic 82-year old male with Lev's disease . (Top) RBBB+LAFB. (Bottom) RBBB+LPFB+1°AVB. Specialty Cardiology
Bifascicular block is characterized by right bundle branch block with left anterior fascicular block , or right bundle branch block with left posterior fascicular block on electrocardiography . Complete heart block could be the cause of syncope that is otherwise unexplained if bifascicular block is seen on electrocardiography .[ 1] atrioventricular block , although the exact incidence is unknown.[ 2]
The European Society of Cardiology (ESC) suggests using electrophysiology studies to look into it (EPS). When pharmacologic stress or incremental atrial pacing induces high-degree atrioventricular block , a permanent pacemaker (PPM) is recommended. If EPS is negative, long-term rhythm monitoring with an implantable loop recorder (ILR) is advised.[ 3]
Most commonly, it refers to a combination of right bundle branch block (RBBB) and either left anterior fascicular block (LAFB) or left posterior fascicular block (LPFB), with the former being more common.[ 4]
Signs and symptoms
Patients who suffer from bifascicular block are more likely to experience syncope and unexpected death.[ 5]
Diagnosis
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Treatment
In those with bifascicular block and no symptoms, little with respect to treatment is needed. In those with syncope , a pacemaker is recommended.[ 6]
See also
References
^ Shabbir, Muhammad Asim; Shaukat, Muhammad Hamza Saad; Ehtesham, Moiz; Murawski, Shannon; Singh, Sukhraj; Alimohammad, Rizwan (2022). "Bifascicular block in unexplained syncope is underrecognized and under-evaluated: A single-center audit of ESC guidelines adherence" . PLOS ONE . 17 (2). PLOS: e0263727. Bibcode :2022PLoSO..1763727S . doi :10.1371/journal.pone.0263727 PMC 8884493 PMID 35226666 . {{cite journal }}: CS1 maint: article number as page number (link )^ M, Brignole; C, Menozzi; A, Moya; R, Garcia-Civera; L, Mont; M, Alvarez; F, Errazquin; J, Beiras; N, Bottoni; P, Donateo (2001). "Mechanism of syncope in patients with bundle branch block and negative electrophysiological test". Circulation . 104 (17): 2045– 2050. doi :10.1161/hc4201.097837 . ISSN 1524-4539 . PMID 11673344 . S2CID 8442192 . ^ M, Brignole; A, Moya; FJ, de Lange; JC, Deharo; PM, Elliott; A, Fanciulli; A, Fedorowski; R, Furlan; RA, Kenny; A, Martín; V, Probst; MJ, Reed; CP, Rice; R, Sutton; A, Ungar; JG, van Dijk (August 28, 2018). "2018 ESC Guidelines for the diagnosis and management of syncope" . European Heart Journal . 39 (21). Eur Heart J: 1883– 1948. doi :10.1093/eurheartj/ehy037 hdl :2262/89469 ISSN 1522-9645 . PMID 29562304 . ^ "Lesson VI — ECG Conduction Abnormalities" . Archived from the original on 16 January 2009. Retrieved 2009-01-07 .^ Ohara, Kuniji; Yamada, Harumoto; Jochheim, David; Mehilli, Julinda; Chandrashekhar, Y.; Narula, Jagat; Lopes, Renato D.; Fanaroff, Alexander C.; Mack, Michael J.; Svensson, Lars G.; Nietlispach, Fabian; Bertel, Osmund (October 1, 1983). "Electrophysiologic evaluation of syncope in patients with bifascicular block" American Heart Journal . 106 (4). Mosby: 693– 697. doi :10.1016/0002-8703(83)90089-3 . ISSN 0002-8703 . PMID 6613815 . Retrieved December 30, 2023 . ^ Epstein, Andrew E.; DiMarco, John P.; Ellenbogen, Kenneth A.; Estes, N.A. Mark; Freedman, Roger A.; Gettes, Leonard S.; Gillinov, A. Marc; Gregoratos, Gabriel; Hammill, Stephen C.; Hayes, David L.; Hlatky, Mark A. (2008-05-27). "ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities" . Circulation . 117 (21): e350-408. doi :10.1161/circualtionaha.108.189742 ISSN 0009-7322 . PMID 18483207 .
Further reading
Steinberg, Jonathan S.; Pokushalov, Evgeny; Zeidan-Shwiri, Tawfiq; Crystal, Eugene; Nakamura, Kohki; Naito, Shigeto; Ávila, Pablo; Arenal, Ángel; Shah, Shivang; Jain, Sandeep; Donnellan, Eoin; Tchou, Patrick (August 1, 1973). "Bifascicular block: A clinical and electrophysiologic study" American Heart Journal . 86 (2). Mosby: 173– 181. doi :10.1016/0002-8703(73)90241-X . ISSN 0002-8703 . PMID 4719938 . Retrieved December 30, 2023 . Kiehl, Erich L.; Cantillon, Daniel J.; Heidecker, Bettina; Jr, Leslie T. Cooper; Singh, Gagan D.; Rogers, Jason H.; Wilson, Ryan E.; Ziada, Khaled M.; John, Roy M.; Jr, Thomas K. Varghese (January 1, 2017). "Bradyarrhythmias—Conduction System Abnormalities" . Arrhythmia Essentials . Elsevier. pp. 28– 86. doi :10.1016/B978-0-323-39968-5.00002-0 . ISBN 9780323399685 . Retrieved December 30, 2023 .
External links
Classification External resources
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