Circulation, Vol 69, 914-923, Copyright © 1984 by American Heart Association
JA Vassallo, DM Cassidy, FE Marchlinski, AE Buxton, HL Waxman, JU Doherty and ME Josephson
Endocardial catheter mapping was performed in 18 patients with left bundle
branch block (LBBB). Four patients had no organic heart disease (group I),
six had cardiomyopathy (group II), and eight had coronary artery disease
and previous infarction (group III). Twelve patients had one septal site of
left ventricular endocardial breakthrough, while six had two left
ventricular endocardial breakthrough sites, with one site always being
septal. There was no significant difference among the groups with respect
to time of left ventricular breakthrough (group I, 44 msec after the onset
of the QRS complex; group II, 58 msec; and group III, 51 msec). Total left
ventricular endocardial activation time was significantly longer in group
III (119 msec) than group I (81 msec; p less than .05) and group II (61
msec; p less than .001). Duration of total right ventricular endocardial
activation was 36 msec (seven patients). The final site of right
ventricular activation was at 44 msec after the onset of the QRS complex.
We conclude that (1) right ventricular activation occurs before initiation
of left ventricular activation in patients with LBBB, (2) left ventricular
endocardial activation in patients with LBBB most likely occurs as a result
of right-to-left transseptal activation, (3) left ventricular endocardial
activation sequence in patients with LBBB is heterogeneous, and (4)
patients with coronary artery disease and LBBB have significantly longer
total left ventricular endocardial activation times than patients with no
organic heart disease or those with cardiomyopathies.
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