Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Mar;24(2):e12572.
doi: 10.1111/anec.12572. Epub 2018 Jun 22.

Left bundle branch block: Epidemiology, etiology, anatomic features, electrovectorcardiography, and classification proposal

Andrés R Pérez-Riera  1 , Raimundo Barbosa-Barros  2 , Marianne P C de Rezende Barbosa  1 , Rodrigo Daminello-Raimundo  1 , Luiz C de Abreu  1 , Kjell Nikus  3
Affiliations
Review

Left bundle branch block: Epidemiology, etiology, anatomic features, electrovectorcardiography, and classification proposal

Andrés R Pérez-Riera et al. Ann Noninvasive Electrocardiol. 2019 Mar.

Abstract

In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients. Advances in cardiac magnetic resonance imaging have significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of left ventricular remodeling. In this review, we will discuss the epidemiology, etiologies, and electrovectorcardiographic features of LBBB and propose a classification of the conduction disturbance.

Keywords: anatomy; classification; epidemiology; etiology; left bundle branch block.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
The three fascicles of the left His system in the left sagittal view. Ao: Aorta; IVC: Inferior Vena Cava; LA: Left Atrium; LBB: Left Bundle Branch; LAF: Left Anterior Fascicle; LSF: Left Septal Fascicle; LPF: Left Posterior Fascicle; PA: Pulmonary Artery; RBB: Right Bundle Branch
Figure 2
Figure 2
Secondary alteration of repolarization in uncomplicated CLBBB
Figure 3
Figure 3
Monophasic R‐wave of slow recording with notching or slurring in the lateral leads I, aVL, V5, and V6. Septal depolarization from right to left makes a wide A–B wave front; however, when the stimulus reaches the central portion of the LV (cavity), it suffers a marked decrease in wavefront width (A′–B′) responsible for the notch in the apex of R‐wave. Next, the wavefront reaches the LV free wall increasing again the width of the wavefront (A″–B″), responsible for the second apex of R‐wave. In severe LVH of the free wall, this second apex presents a higher voltage relative to the first one
Figure 4
Figure 4
(a) ECG/VCG correlation of CLBBB and the four vectors of depolarization in LBBB in the HP; (b) ECG/VCG correlation in the FP
Figure 5
Figure 5
Fascicular LBBB is rarely possible qR pattern in lateral leads because the LSF arises from LBBB trunk. LAFB: Left Anterior Fascicular Block; LBB: Left Bundle Branch; LPFB: Left Posterior Fascicular Block; LSF: Left Septal Fascicle
See this image and copyright information in PMC

References

    1. Akhbour, S. , Fellat, I. , Fennich, N. , Abdelali, S. , Doghmi, N. , Ellouali, F. , & Cherti, M. (2015). Electrocardiographic findings in correlation to magnetic resonance imaging patterns in African patients with isolated ventricular noncompaction. The Anatolian Journal of Cardiology, 15(7), 550–555. 10.5152/akd.2014.5577 - DOI - PMC - PubMed
    1. Bayés de Luna, A. (1998). Clinical electrocardiography: A textbook (2nd ed.). Armonk: , NY: Futura Publishing Company Inc.
    1. Bellavia, D. , Pellikka, P. A. , Abraham, T. P. , Al‐Zahrani, G. B. , Dispenzieri, A. , Oh, J. K. , … Miller, F. A. (2009). 'Hypersynchronisation' by tissue velocity imaging in patients with cardiac amyloidosis. Heart, 95(3), 234–240. 10.1136/hrt.2007.140343 - DOI - PubMed
    1. Bharati, S. , Lev, M. , Dhingra, R. C. , Chuquimia, R. , Towne, W. D. , & Rosen, K. M. (1975). Electrophysiologic and pathologic correlations in two cases of chronic second degree atrioventricular block with left bundle branch block. Circulation, 52(2), 221–229. 10.1161/01.CIR.52.2.221 - DOI - PubMed
    1. Blanc, J. J. , Fatemi, M. , Bertault, V. , Baraket, F. , & Etienne, Y. (2005). Evaluation of left bundle branch block as a reversible cause of non‐ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony‐induced cardiomyopathy. Europace, 7(6), 604–610. 10.1016/j.eupc.2005.06.005 - DOI - PubMed

LinkOut - more resources