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Left anterior fascicular block: The need for a re-appraisal

2018; Elsevier BV; Volume: 269; Linguagem: Inglês

10.1016/j.ijcard.2018.07.079

1874-1754

Larisa G. Tereshchenko,

Cardiac pacing and defibrillation studies

Pathologists were the first who recognized and described the conduction system of the heart. Jan Evangelista Purkyně (Purkinje) in 1839 described distinct Purkyně fibers, forming Purkyně's network. In 1893, Dr. Wilhelm His Jr. discovered the bundle of the specialized conduction tissue, connecting the upper and lower cardiac chambers (the bundle of His), described fascicular intraventricular conduction system, and identified the heart block as the cause of the Adams-Stokes syndrome. It took longer to understand the functioning of the intraventricular conduction system, and to develop electrocardiographic (ECG) diagnostic criteria of ventricular conduction abnormalities. Frank Wilson [ [1] Wilson F.N. Macleod A.G. Barker P.S. The interpretation of the initial deflections of the ventricular complex of the electrocardiogram. Am. Heart J. 1931; 6: 637-664 Crossref Scopus (14) Google Scholar ] in 1934 was the first who suggested that the block of the anterior fascicle of the left bundle may explain left axis deviation in some right bundle branch block (RBBB) cases. In 1956, Grant [ [2] Grant R.P. Left axis deviation; an electrocardiographic-pathologic correlation study. Circulation. 1956; 14: 233-249 Crossref PubMed Scopus (94) Google Scholar ] suggested that left axis deviation might be due to a block of the anterior fibers of the left bundle branch. In 1969, Rosenbaum et al. [ [3] Rosenbaum M.B. Elizari M.V. Lazzari J.O. Nau G.J. Levi R.J. Halpern M.S. Intraventricular trifascicular blocks. The syndrome of right bundle branch block with intermittent left anterior and posterior hemiblock. Am. Heart J. 1969; 78: 306-317 Crossref PubMed Scopus (73) Google Scholar ] described ECG criteria of the left anterior fascicular block (LAFB). In our time, after more than 50 years of LAFB research, its definition and clinical significance remain controversial. In this issue of the Journal, Ding et al. [ [4] Ding S. Chai K. Li Y. Fang F. Yang J. Wang H. Prognostic significance of left anterior fascicular block and its relation with coronary artery disease in old patients based on 570 autopsy cases. Int. J. Cardiol. 2018; 269: 1-6 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ] reported autopsy-validated outcomes in individuals with LAFB, confirming the clinical importance of LAFB: all-cause and cardiovascular mortality was significantly higher in patients with LAFB. Prognostic significance of left anterior fascicular block and its relation with coronary artery disease in old patients based on 570 autopsy casesInternational Journal of CardiologyVol. 269PreviewLeft Anterior Fascicular Block (LAFB) occurs frequently among the elderly, and have a correlation with coronary artery disease (CAD), yet controversies regarding its clinical significance still remain. Full-Text PDF