Fascicular Blocks: Update 2019

Many advances in the knowledge of medical science are due to the observation of an unknown phenomenon that remains an open question. A plausible hypothesis must be demonstrated and proved through a scientific method in order to be accepted by the scientific community and the same results must be reached by following either the same or different techniques. The original case described by Rosenbaum MB et al., in this review triggered a series of anatomic and physiologic investigations with clinical and experimental observations that supported the trifascicular nature of the intraventricular conduction system of the heart and the concept of hemiblocks. The recognition and description of the left fascicular blocks made by the Argentinian School of Electrocardiology bridged an important gap in electrocardiography and many electrocardiograms that could not be explained until that moment could finally be understood. This review intends to redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left fascicular blocks [hemiblocks]. The anatomy of the left bundle branch is also discussed to better understand the incidence, prevalence, clinical significance and main causes of left anterior and left posterior hemiblock either isolated or associated with right bundle branch block. This review offers the reader a reappraisal of the trifascicular nature of the intraventricular conduction system regarding the anatomy of the left bundle branch system and its pathophysiological and clinical significance.