Intraventricular conduction delay causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]

Overview

Intraventricular conduction delays(IVCDs) refers to abnormalities in the intraventricular propagation of supraventricular impulses. These abnormalities can be due to pathology in either the left bundle of His or its fascicular branches or the right bundle of His or its combination resulting in changes to the QRS complex. Causes can be classified based upon the site of pathology in the ventricular conduction system as well as the associated medical condition.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Left Bundle Branch Block Causes

LBBB usually appears in patients with underlying heart disease such as hypertensive heart disease, valvular heart disease, cardiomyopathy etc. Most patients with left ventricular hypertrophy and coronary artery disease of LAD show left bundle branch block (LBBB) conduction delay pattern on the surface electrocardiogram (ECG).

Right Bundle Branch Block Causes

RBBB is a common finding in the general population when compared to LBBB, and many persons with RBBB have no clinical evidence of underlying heart disease. Right side valvular heart diseases, COPD, coronary artery disease show right bundle branch block (RBBB) conduction delay pattern on the surface electrocardiogram (ECG).

Left Anterior Fascicular Block Causes

Isolated LAFB is very common when compared to LPFB. This conduction delay pattern on ECG may be seen with hypertension, aortic valve disease, coronary disease of LAD artery septal branch and sometimes in general population without identifiable cause.

Left Posterior Fascicular Block Causes

Isolated LPFB is very rare when compared to LAFB. Most often it occurs with RBBB in patients with chronic lung disease and right ventricular hypertrophy.

Left Median Fascicular Block Causes

Isolate LMFB that occurs due to pathology involving interventricular septum is rare. A number of neuromuscular diseases are associated with fascicular block.

Multifascicular Block Causes

Multifascicular block refers to conduction delay or block in more than one of the structural components of the specialized conduction system—that is, the left bundle branch, the left anterior and posterior fascicles of the left bundle branch, and the right bundle branch. Conduction delay in any two fascicles is termed bifascicular block, and delay in all three fascicles is termed trifascicular block. Causes of multifascicular block are those which cause individual blocks and the most common are LVH, RVH and coronary heart disease.

References

  1. ↑ Nakajima M, Aomi S, Matsuda N, Kasanuki H, Endo M, Kurosawa H (2003). "Simultaneous biventricular pacemaker implantation for a surgical case of aortic regurgitation with severe left ventricular dysfunction and left bundle branch block". The Journal of Thoracic and Cardiovascular Surgery. 125 (5): 1167–9. doi:10.1067/mtc.2003.304. PMID 12771896. Unknown parameter |month= ignored (help)
  2. ↑ Wieslander B, Wu KC, Loring Z; et al. (2013). "Localization of myocardial scar in patients with cardiomyopathy and left bundle branch block using electrocardiographic Selvester QRS scoring". Journal of Electrocardiology. doi:10.1016/j.jelectrocard.2013.02.006. PMID 23540937. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Arce M, VAN Grieken J, Femenía F, Arrieta M, McIntyre WF, Baranchuk A (2012). "Permanent pacing in patients with Chagas' disease". Pacing and Clinical Electrophysiology : PACE. 35 (12): 1494–7. doi:10.1111/pace.12013. PMID 23078655. Unknown parameter |month= ignored (help)
  4. ↑ Grimm W (2012). "Prophylactic implantable defibrillators in dilated cardiomyopathy". Herz. 37 (8): 859–66. doi:10.1007/s00059-012-3687-9. PMID 23052902. Unknown parameter |month= ignored (help)
  5. ↑ Foell D, Jung BA, Germann E; et al. (2013). "Segmental myocardial velocities in dilated cardiomyopathy with and without left bundle branch block". Journal of Magnetic Resonance Imaging : JMRI. 37 (1): 119–26. doi:10.1002/jmri.23803. PMID 22987362. Unknown parameter |month= ignored (help)
  6. ↑ Stein R, Ho M, Oliveira CM; et al. (2011). "Exercise-induced left bundle branch block: prevalence and prognosis". Arquivos Brasileiros De Cardiologia. 97 (1): 26–32. PMID 21552647. Unknown parameter |month= ignored (help)
  7. ↑ Iscove NN, Yan XQ (1990). "Precursors (pre-CFCmulti) of multilineage hemopoietic colony-forming cells quantitated in vitro. Uniqueness of IL-1 requirement, partial separation from pluripotential colony-forming cells, and correlation with long term reconstituting cells in vivo". Journal of Immunology (Baltimore, Md. : 1950). 145 (1): 190–5. PMID 2358672. Unknown parameter |month= ignored (help)
  8. ↑ Kutyifa V, Pouleur AC, Knappe D; et al. (2013). "Dyssynchrony and the risk of ventricular arrhythmias". JACC. Cardiovascular Imaging. 6 (4): 432–44. doi:10.1016/j.jcmg.2012.12.008. PMID 23579010. Unknown parameter |month= ignored (help)
  9. ↑ Cinca J, Mendez A, Puig T; et al. (2013). "Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure". European Journal of Heart Failure. doi:10.1093/eurjhf/hft042. PMID 23512097. Unknown parameter |month= ignored (help)
  10. ↑ Hanson EH, Shue PM, Palm-Leis A, Rowley RK (2001). "An aviator with cardiomyopathy and genetic susceptibility to hereditary hemochromatosis: a case report". Aviation, Space, and Environmental Medicine. 72 (10): 924–7. PMID 11601557. Unknown parameter |month= ignored (help)
  11. ↑ Rodrigues B, Correia E, Ferreira Santos L; et al. (2013). "Left bundle branch block, atrioventricular block, torsade de pointes and long QT syndrome: is this too much for a rare cardiomyopathy?". Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology. doi:10.1016/j.repc.2012.06.018. PMID 23618687. Unknown parameter |month= ignored (help)
  12. ↑ Gerecke B, Engberding R (2012). "[Isolated noncompaction cardiomyopathy with special emphasis on arrhythmia complications]". Herzschrittmachertherapie & Elektrophysiologie (in German). 23 (3): 201–10. doi:10.1007/s00399-012-0226-6. PMID 23008085. Unknown parameter |month= ignored (help)
  13. ↑ 13.0 13.1 Davies MJ (1976). "Pathology of chronic A-V Block". Acta Cardiologica. Suppl 21: 19–30. PMID 1087803.
  14. ↑ http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8159.1990.tb04009.x/abstract
  15. ↑ Di Bella G, Florian A, Oreto L; et al. (2012). "Electrocardiographic findings and myocardial damage in acute myocarditis detected by cardiac magnetic resonance". Clinical Research in Cardiology : Official Journal of the German Cardiac Society. 101 (8): 617–24. doi:10.1007/s00392-012-0433-5. PMID 22388951. Unknown parameter |month= ignored (help)
  16. ↑ Deluigi CC, Ong P, Hill S; et al. (2013). "ECG findings in comparison to cardiovascular MR imaging in viral myocarditis". International Journal of Cardiology. 165 (1): 100–6. doi:10.1016/j.ijcard.2011.07.090. PMID 21885134. Unknown parameter |month= ignored (help)
  17. ↑ Kumar PD, Sahasranam KV, Chandrasekharan KG (1993). "Deceleration--dependent left bundle branch block in rheumatic carditis". The Journal of the Association of Physicians of India. 41 (3): 171–2. PMID 8226603. Unknown parameter |month= ignored (help)
  18. ↑ Yahalom M, Jerushalmi J, Roguin N (1990). "Adult acute rheumatic fever: a rare case presenting with left bundle branch block". Pacing and Clinical Electrophysiology : PACE. 13 (1): 123–7. PMID 1689027. Unknown parameter |month= ignored (help)
  19. ↑ Dechering DG, Kochhäuser S, Wasmer K; et al. (2013). "Electrophysiological characteristics of ventricular tachyarrhythmias in cardiac sarcoidosis versus arrhythmogenic right ventricular cardiomyopathy". Heart Rhythm : the Official Journal of the Heart Rhythm Society. 10 (2): 158–64. doi:10.1016/j.hrthm.2012.10.019. PMID 23070261. Unknown parameter |month= ignored (help)
  20. ↑ Femenía F, Arce M, Arrieta M (2010). "[Systemic sclerosis complicated with syncope and complete AV block]". Medicina (in Spanish; Castilian). 70 (5): 442–4. PMID 20920962.
  21. ↑ Urena M, Mok M, Serra V; et al. (2012). "Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve". Journal of the American College of Cardiology. 60 (18): 1743–52. doi:10.1016/j.jacc.2012.07.035. PMID 23040577. Unknown parameter |month= ignored (help)
  22. ↑ Colombo A, Latib A (2012). "Left bundle branch block after transcatheter aortic valve implantation: inconsequential or a clinically important endpoint?". Journal of the American College of Cardiology. 60 (18): 1753–5. doi:10.1016/j.jacc.2012.07.034. PMID 23040576. Unknown parameter |month= ignored (help)

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