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Left bundle branch block with left-axis deviation: an electrophysiologic approach.

A Gressard

    The American Journal of Cardiology
    |November 1, 1983
    PubMed
    Summary

    Left bundle branch block (LBBB) explains left-axis deviation (LAD). Stimulating the right ventricle apex in LBBB patients produces a consistent QRS axis, clarifying ventricular depolarization patterns.

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    Area of Science:

    • Cardiology
    • Electrophysiology

    Background:

    • Left bundle branch block (LBBB) is associated with left-axis deviation (LAD), but the precise electrophysiological mechanisms remain incompletely understood.
    • Understanding these mechanisms is crucial for accurate diagnosis and patient management.

    Purpose of the Study:

    • To investigate the relationship between LBBB, QRS axis, and ventricular depolarization patterns.
    • To elucidate the role of the left bundle branch in left ventricular depolarization.

    Main Methods:

    • Studied 69 patients with LBBB, divided into two groups based on QRS axis.
    • Identified a right ventricular apex activation point (V-apex = 0) and performed ventricular stimulation.
    • Analyzed QRS axis and morphology during atrial premature beats to assess conduction aberrations.

    Main Results:

    • Right ventricular apex stimulation consistently produced a QRS axis of -60 degrees.
    • Conduction aberrations during premature beats in LBBB patients resulted in LAD, with axes similar to right ventricular apex stimulation.
    • Patients with LBBB and monomorphic QRS morphology suggest intact left bundle branch conduction.

    Conclusions:

    • The left bundle branch significantly influences left ventricular depolarization and QRS axis in LBBB.
    • Blocking the left bundle branch shifts the QRS axis towards patterns seen with right ventricular apex stimulation.
    • Monomorphic LBBB morphology is expected; deviations suggest slowed conduction within the left bundle branch.

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