Open AccessThe tetrafascicular nature of the intraventricular conduction system
Author(s) -
PérezRiera Andrés R.,
BarbosaBarros Raimundo,
DaminelloRaimundo Rodrigo,
de Abreu Luiz C.,
Nikus Kjell
Publication year - 2019
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23093
Subject(s) - medicine , fascicle , intraventricular conduction , bradycardia , left bundle branch block , cardiology , electrical conduction system of the heart , anatomy , ischemia , electrophysiology , electrocardiography , heart rate , heart failure , blood pressure
The existence of a tetrafascicular intraventricular conduction system remains debatable. A consensus statement ended up with some discrepancies and, despite agreeing on the possible existence of an anatomical left septal fascicle, the electrocardiographic and vectorcardiographic characteristics of left septal fascicular block (LSFB) were not universally accepted. The most important criteria requested to confirm the existence of LSFB is its intermittent nature. So far, our group has published cases of transient ischemia‐induced LSFB and phase 4 or bradycardia‐dependent LSFB. Finally, anatomical, anatomopathological, histological, histopathological, electrocardiographic, vectorcardiographic, body surface potential mapping, and electrophysiology studies support the fact that the left bundle branch divides into three fascicles or a “fan‐like interconnected network.”