[Disorders of intraventricular conduction]

An electrophysiologic approach to intraventricular conduction disturbances, preeminently functional phenomena, is presented. They are divided into two groups: the proximal type corresponding to obstruction of excitation impulses in the main trunk of one intraventricular specific system; distal or peripheral type, due to an obstruction in the distal subdivisions of the system (fascicular) or to regional myocardial alterations (parietal). Trunkal blocks produce global delay of the activation sequence of the ipsilateral ventricular myocardium. Consequently they are recognized by slurred R waves and delayed time of onset of intrinsicoid deflection in all ipsilateral leads. Distal or peripheral blocks cause a segmentary delay of the activation phenomenon of ipsilateral ventricular myocardium. This is revealed by slurred R waves and delayed time of onset of intrinsicoid deflection only in those leads which explore the affected region. Peripheral blocks can be classified from a topographic point of view when they appear in the area of distal subdivisions of the intraventricular conduction system.