Epicardial activation in human left anterior fascicular block. |
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Authors: | C R Wyndham M K Meeran T Smith R M Engelman S Levitsky K M Rosen |
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Affiliation: | From the Section of Cardiology, Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois, Chicago, Illinois, U.S.A. |
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Abstract: | Four patients with coronary artery disease and chronic marked left axis deviation, defined as a frontal QRS axis more negative than -45 degrees, were studied with epicardial mapping during coronary bypass surgery. All patients had normal right ventricular and inferior left ventricular epicardial breakthrough sites and activation sequence. Normal breakthrough in the basal anterolateral left ventricular epicardium was absent in all four patients. Two patients had breakthrough in the apical region of the anterolateral left ventricle. In the other two this region was activated from wave fronts emerging in the right ventricle and inferior left ventricle. The latest site of left ventricular activation was the basal segment of the anterolateral wall, a site never found to be the latest activated in our previously studied patients without conduction defects. This site was activated during or slightly after the terminal portion of the QRS complex. It is concluded that marked left axis deviation in patients with coronary artery disease reflects delayed activation of the basal anterolateral left ventricle, and is consistent with the presence of block or delay in the anterior "fascicle" of the left bundle branch. |
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Keywords: | Address for reprints: Christopher R. Wyndham MB Section of Cardiology Department of Medicine Abraham Lincoln School of Medicine P.O. Box 6998 Chicago Illinois 60680. |
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