Advances in the understanding of conduction disturbances

The interest towards intraventricular conduction defects started some 10 yr after the introduction of the string galvanometer by Einthoven. As early as 1910, it was known that conduction blockade could occur along either branch of the intraventricular conducting pathway. It took some 20 yr to identify properly the electrocardiographic manifestations of right and left bundle branch blocks. A further 30 yr were needed to obtain a sound correlation between these functional disorders and the presence of anatomical lesions. The more recent introduction of the concept of left hemiblocks further improved our understanding of intraventricular conduction defects. The latter concept is based on the hypothesis of the anatomical and functional bifascicularity of the left bundle branch, a hypothesis which cannot be accepted without some reservations. Later developments indicated that left hemiblocks associated with right bundle branch block represent manifestations of bilateral conduction disturbances (incomplete bilateral bundle branch block). Such an association may constitute a forerunner of complete atrioventricular block, or an indicator of the possibility of sudden death. Whether these complications occur frequently or unfrequently in the setting of incomplete bilateral bundle branch block remains an unsettled question.