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[Left bifascicular block and percutaneous mitral valvuloplasty]
F Fernandez1, R Soria, P Rocha
1Service de Cardiologie, Hôpital Boucicaut, Paris.
Insights
Percutaneous mitral valvuloplasty can cause left bundle branch block, specifically a "biblock." This finding supports the trifascicular concept of the left bundle branch in cardiac conduction.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Percutaneous mitral valvuloplasty (PMV) is a procedure to treat mitral stenosis.
- Intraventricular conduction abnormalities can occur during PMV due to balloon inflation.
- The left bundle branch of the His bundle is crucial for ventricular depolarization.
Abstract:
In some patients, the inflation of balloons through the mitral orifice during percutaneous mitral valvuloplasties may impair intraventricular conduction. In some cases, this appears to correspond to a block of the anterior and middle network within the left branch of the bundle of His. This left "biblock" is characterized by extreme left axial deviation of AQRS, of about -60 to -70 degrees, with a QS aspect on D2 and D3, RS on V1 and R on V6 with no major prolongation of ventricular activation time. If this hypothesis is correct, it would support the "trifascicular" concept of the left branch of the bundle of His.