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Right Bundle Branch Block With Periods of Alternating Left Anterior and Left Posterior Hemiblock

Clinical Evidence of Incomplete Fascicular Block

Department of Medicine, Division of Cardiology, Mount Sinai Services, City Hospital Center at Elmhurst, Mount Sinai School of Medicine of the City University of New York, and Maimonides Medical Center

Carlos Ribas-Meneclier

Department of Medicine, Division of Cardiology, Mount Sinai Services, City Hospital Center at Elmhurst, Mount Sinai School of Medicine of the City University of New York, and Maimonides Medical Center

Prem K. Gupta

Department of Medicine, Division of Cardiology, Mount Sinai Services, City Hospital Center at Elmhurst, Mount Sinai School of Medicine of the City University of New York, and Maimonides Medical Center

Kul D. Chadda

Department of Medicine, Division of Cardiology, Mount Sinai Services, City Hospital Center at Elmhurst, Mount Sinai School of Medicine of the City University of New York, and Maimonides Medical Center

The case presented had an electrocardiographic pattern of complete right bundle branch block with alternating periods of left anterior hemiblock and left posterior hemiblock. During one of the periods of alternating hemiblock, an His bundle electrogram was recorded and the His Purkinje (H-V interval) conduction time was within normal limits. In a second episode of alternating hemiblock, periods of Mobitz type II second-degree A-V block were noted. It is postulated that this case provides clinical evidence that incomplete block of a fascicle may occur in spite of an electrocardiographic pattern of complete fascicular block. It is thought that the periods of alternating hemiblock result from a changing relationship between conduction velocity and refractory pe riod.

Angiology, Vol. 29, No. 11, 862-869 (1978)
DOI: 10.1177/000331977802901111


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