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Hemiblocks revisited.
Circulation 2007; 115(9):1154-63Circ

Abstract

The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures.

Authors+Show Affiliations

Division of Cardiology, Ramos Mejía Hospital, Urquiza 609, Buenos Aires C1221ADC, Argentina. elizarimv@fibertel.com.arNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17339573

Citation

Elizari, Marcelo V., et al. "Hemiblocks Revisited." Circulation, vol. 115, no. 9, 2007, pp. 1154-63.
Elizari MV, Acunzo RS, Ferreiro M. Hemiblocks revisited. Circulation. 2007;115(9):1154-63.
Elizari, M. V., Acunzo, R. S., & Ferreiro, M. (2007). Hemiblocks revisited. Circulation, 115(9), pp. 1154-63.
Elizari MV, Acunzo RS, Ferreiro M. Hemiblocks Revisited. Circulation. 2007 Mar 6;115(9):1154-63. PubMed PMID: 17339573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemiblocks revisited. AU - Elizari,Marcelo V, AU - Acunzo,Rafael S, AU - Ferreiro,Marcela, PY - 2007/3/7/pubmed PY - 2007/3/28/medline PY - 2007/3/7/entrez SP - 1154 EP - 63 JF - Circulation JO - Circulation VL - 115 IS - 9 N2 - The trifascicular nature of the intraventricular conduction system and the concept of trifascicular block and hemiblock were described by Rosenbaum and his coworkers in 1968. Since then, anatomic, pathological, electrophysiological, and clinical studies have confirmed the original description and scarce advances have been developed on the subject. In the present study, we attempt to review and redefine reliable criteria for the electrocardiographic and vectorcardiographic diagnosis of left anterior and posterior hemiblock. One of the most important problems related to hemiblocks is that they may simulate or conceal the electrocardiographic signs of myocardial infarction or myocardial ischemia and may mask or simulate ventricular hypertrophy. Illustrative examples of these associations are shown to help the interpretation of electrocardiograms. The incidence and prevalence of the hemiblocks is presented based on studies performed in hospital patients and general populations. One of the most common causes of hemiblocks is coronary artery disease, and there is a particularly frequent association between anteroseptal myocardial infarction and left anterior hemiblock. The second most important cause is arterial hypertension, followed by cardiomyopathies and Lev and Lenègre diseases. The hemiblocks may also occur in aortic heart disease and congenital cardiopathies. Left anterior hemiblock is more common in men and increases in frequency with advancing age. Evidence is presented regarding the relationship of spontaneous closure of ventricular septal defects, which may explain the finding of this and other conduction defects in young populations. Isolated left anterior hemiblock is a relatively frequent finding in subjects devoid of evidence of structural heart disease. Conversely, isolated left posterior hemiblock is a very rare finding; its prognostic significance is unknown and is commonly associated with right bundle-branch block. The most remarkable feature of this association is that the prognosis is much more serious with a great propensity to develop complete atrioventricular block and Adams-Stoke seizures. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17339573/Hemiblocks_revisited_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.637389?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -