Quantitative study of left bundle branch fibrosis in left anterior hemiblock: A stereologic approach

Serial sectioning of the interventricular septum was carried out in 16 hearts, 8 from elderly subjects with no conduction disturbance and 8 from patients with chronic left anterior hemiblock. The histologic slides were studied stereologically, and the relative density of fibrosis was quantitatively assessed by the point counting technique at various levels of the main subdivisions of the left bundle branch system. Statistical analysis revealed the following: (1) Although some fibrosis was found in the control hearts, the density of fibrosis was consistently and significantly greater throughout the conduction system in patients with left anterior hemiblock. (2) In the group with hemiblock, the relative density of fibrosis tended to increase significantly from the posterior ramification to the midseptal fibers and, finally, to the anterior fascicle. (3) Among the eight patients with hemiblock, fibrosis appeared to be evenly distributed throughout the conduction system in four. It was predominantly located in the anterior and midseptal fibers in one patient and showed an increasing severity from the posterior to the midseptal and anterior fibers in the remaining three patients. From this quantitative study, it is concluded that left anterior hemiblock is a reliable sign of left bundle branch disease but that the underlying lesions are more widely distributed than would be from the expected electrocardiographic terminology since they were found predominantly in the anterior ramifications in only half of the studied cases.