Pediatric Left Bundle Branch Block Differential Diagnoses

  • Author: Bahram Kakavand, MD, FACC; Chief Editor: Stuart Berger, MD   more...
 
Updated: Apr 16, 2012
 
 

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Bahram Kakavand, MD, FACC  Assistant Professor of Pediatrics, Pediatric Cardiology and Electrophysiology, University of Kentucky College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Christopher Johnsrude, MD, MS  Chief, Division of Pediatric Cardiology, University of Louisville School of Medicine; Director, Congenital Heart Center, Kosair Children's Hospital

Christopher Johnsrude, MD, MS is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology

Disclosure: St Jude Medical Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD  Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Christopher Mart, MD, to the development and writing of this article.

References

  1. Flowers NC. Left bundle branch block: a continuously evolving concept. J Am Coll Cardiol. Mar 1987;9(3):684-97. [Medline].

  2. Chien SJ, Liang CD, Lin IC, Lin YJ, Huang CF. Myocarditis complicated by complete atrioventricular block: nine years' experience in a medical center. Pediatr Neonatol. Dec 2008;49(6):218-22. [Medline].

  3. Blanc JJ, Fatemi M, Bertault V, et al. Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony-induced cardiomyopathy. Europace. Nov 2005;7(6):604-10. [Medline].

  4. Diogenes MS, Succi RC, Machado DM, et al. Cardiac longitudinal study of children perinatally exposed to human immunodeficiency virus type 1 [in Portuguese]. Arq Bras Cardiol. Oct 2005;85(4):233-40. [Medline].

  5. Kasmani R, Okoli K, Mohan G, Casey K, Ledrick D. Transient left bundle branch block: an unusual electrocardiogram in acute pulmonary embolism. Am J Med Sci. May 2009;337(5):381-2. [Medline].

  6. Calabro MP, Cerrito M, Luzza F, Oreto G. Alternating right and left bundle branch block aberration during atrial tachycardia. J Electrocardiol. Apr 17 2009;[Medline].

  7. [Guideline] Wagner GS, Macfarlane P, Wellens H, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. Mar 17 2009;53(11):1003-11. [Medline].

  8. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. May 27 2008;51(21):e1-62. [Medline].

  9. Shen X, Aronow WS, Holmberg MJ, et al. Cardiac resynchronization therapy in patients with intrinsic and right ventricular pacing-induced left bundle branch block pattern. Am J Ther. Nov-Dec 2009;16(6):e44-50. [Medline].

  10. Delnoy PP, Ottervanger JP, Luttikhuis HO, et al. Long-term clinical response of cardiac resynchronization after chronic right ventricular pacing. Am J Cardiol. Jul 1 2009;104(1):116-21. [Medline].

  11. Becker AE, Anderson RH. Morphology of the human atrioventricular junctional area. In: Wellens JHH, Lie KI, Janse MJ, eds. The Conduction System of the Heart. Philadelphia, PA: Lea & Febiger; 1976:263-71.

  12. Castellanos A, Kessler KM, Myerburg RJ. The resting electrocardiogram. In: Schlant RC, Alexander RW, eds. Hurst's The Heart. 8th ed. New York, NY: McGraw-Hill Medical; 1994:330-7.

  13. Colvin EV. Cardiac embryology. In: Garson A, Bricker JT, Fisher DJ, Neish SR, eds. The Science and Practice of Pediatric Cardiology. 2nd ed. Baltimore, MD: Williams & Wilkins; 1998:91-123.

  14. Demoulin JC, Kulbertus HE. Histopathologic correlates of left posterior fascicular block. Am J Cardiol. Nov 1979;44(6):1083-8. [Medline].

  15. Dubin D. Rapid Interpretation of EKGs. 3rd ed. Tampa, FL: Cover; 1984:137-42.

  16. Garson A. Interventricular conduction disturbances. In: The Electrocardiogram in Infants and Children: A Systematic Approach. Philadelphia, PA: Lea & Febiger; 1983:119-42.

  17. Garson A. Electrocardiography. In: Garson A, Bricker JT, Fisher DJ, Neish SR, eds. The Science and Practice of Pediatric Cardiology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1997:736.

  18. Gillette PC, Garson A. Pediatric Arrhythmias: Electrophysiology and Pacing. Philadelphia, PA: WB Saunders; 1990:317-27.

  19. Hamby RI, Weissman RH, Prakash MN, Hoffman I. Left bundle branch block: a predictor of poor left ventricular function in coronary artery disease. Am Heart J. Sep 1983;106(3):471-7. [Medline].

  20. Husson GS, Blackman MS, Rogers MC, et al. Familial congenital bundle branch system disease. Am J Cardiol. Sep 7 1973;32(3):365-9. [Medline].

  21. James TN. The connecting pathways between the sinus node and A-V node and between the right and the left atrium in the human heart. Am Heart J. Oct 1963;66:498-508. [Medline].

  22. Keefe DL, Griffin JC, Harrison DC, Stinson EB. Atrioventricular conduction abnormalities in patients undergoing isolated aortic or mitral valve replacement. Pacing Clin Electrophysiol. May 1985;8(3 Pt 1):393-8. [Medline].

  23. Krikler DM, Lefevre D. Intermittent left bundle-branch block without obvious heart-disease. Lancet. Mar 7 1970;1(7645):498-500. [Medline].

  24. Leibman J, Plonsey R, Gillette PC. Interruption of conduction abnormalities. In: Pediatric Electrocardiography. Philadelphia, PA: Lippincott Williams & Wilkins; 1985:172-91.

  25. Li TC, Hu DY, Bian H, et al. Effects of transcatheter closure of perimembranous ventricular septal defects: intermediate and long-term follow-up of 68 cases [in Chinese]. Zhonghua Yi Xue Za Zhi. Oct 26 2005;85(40):2846-9. [Medline].

  26. Lopes VM, Miguel JM, dos Reis DD, et al. Left-posterior hemiblock. Clinical and vectorcardiographic study of twenty cases. J Electrocardiol. 1974;7(3):197-214. [Medline].

  27. Massing GK, James TN. Anatomical configuration of the His bundle and bundle branches in the human heart. Circulation. Apr 1976;53(4):609-21. [Medline].

  28. Milliken JA. Isolated and complicated left anterior fascicular block: a review of suggested electrocardiographic criteria. J Electrocardiol. Apr 1983;16(2):199-211. [Medline].

  29. Perloff JK, Roberts NK, Cabeen WR Jr. Left axis deviation: a reassessment. Circulation. Jul 1979;60(1):12-21. [Medline].

  30. Pickhoff AS. Electrophysiology: development and function of the cardiac conduction system. In: Allen HD, Gutgesell HP, Clark EB, Driscoll DJ, eds. Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:414-24.

  31. Rossi L. Histopathology of Cardiac Arrhythmias. 2nd ed. Philadelphia, PA: Lea & Febiger; 1979:1-75.

  32. Schaal SF, Seidensticker J, Goodman R, Wooley CF. Familial right bundle-branch block, left axis deviation, complete heart block, and early death. A heritable disorder of cardiac conduction. Ann Intern Med. Jul 1973;79(1):63-6. [Medline].

  33. Sharratt GP, Virmani S. Left-axis deviation in otherwise healthy children. Pediatr Cardiol. 1985;6(1):7-9. [Medline].

  34. Shaver JA, Salerni R. Auscultation of the heart. In: Schlant RC, Alexander RW, eds. Hurst's The Heart. 8th ed. New York, NY: McGraw Hill Medical; 1994:269.

  35. Silka MJ. Bundle branch block. In: Garson A, Bricker JT, Fisher DJ, Neish SR, eds. The Science and Practice of Pediatric Cardiology. Philadelphia, PA: Lippincott, Williams & Wilkins; 1997:2033-45.

  36. Stollberger C, Winkler-Dworak M, Blazek G, et al. Age-dependency of cardiac and neuromuscular findings in left ventricular noncompaction. Int J Cardiol. Jul 28 2006;111(1):131-5. [Medline].

  37. Sun XJ, Gao W, Zhou AQ, et al. Risk factors for arrhythmia early after transcatheter closure of perimembranous ventricular septal defects [in Chinese]. Zhonghua Er Ke Za Zhi. Oct 2005;43(10):767-71. [Medline].

  38. Tawara S. Das Reizleitungssystem des Saugetierkerzens. Jena: Gustav Fisher; 1906.

  39. Van Praagh R, Van Praagh S. Morphologic anatomy. In: Fyler, DC, ed. Nadas' Pediatric Cardiology. Philadelphia, PA: Hanley & Belfus; 1992:23.

  40. Waller BF, Schlant RC. Anatomy of the heart. In: Schlant RC, Alexander RW, eds. Hurst's The Heart. 8th ed. New York, NY: McGraw-Hill Medical; 1994:99-102.

  41. Walsh, EP. Electrocardiography and introduction to electrophysiologic techniques. In: Fyler, DC, ed. Nadas' Pediatric Cardiology. Philadelphia, PA: Hanley & Belfus; 1992:134.

  42. Youn HJ, Park CS, Cho EJ, et al. Left bundle branch block disturbs left anterior descending coronary artery flow: study using transthoracic Doppler echocardiography. J Am Soc Echocardiogr. Oct 2005;18(10):1093-8. [Medline].

 
Previous
Next
 
ECGs show a normal sinus rhythm and a sinus rhythm with a left bundle branch block.
Anatomy of the penetrating portion of the atrioventricular (AV) bundle.
ECG depicts electrophysiologic events in normal cardiac conduction. AV = atrioventricular.
Pathophysiology of left bundle branch block. AV = atrioventricular; LV = left ventricular; RV = right ventricular.
ECG depicts electrophysiologic events of left bundle branch block.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.