Further Observations on the Etiology of the Right Bundle Branch Block Pattern Following Right Ventriculotomy

Author:

KRONGRAD EHUD1,HEFLER STEPHEN E.1,BOWMAN FREDERICK O.1,MALM JAMES R.1,HOFFMAN BRIAN F.1

Affiliation:

1. From the Department of Pediatrics, Surgery and Pharmacology, College of Physicians and Surgeons, Columbia University and the Surgical Service of the Presbyterian Hospital, New York, New York.

Abstract

Fifteen patients with various congenital heart defects were studied during open heart surgery in order to establish the precise mechanism by which a right ventriculotomy causes a right bundle branch block (RBBB) pattern on the scalar electrocardiogram (ECG). All required a right ventriculotomy for the correction of their defects. In each, the right ventriculotomy was carried out in steps, with incisions (3 to 7) of approximately 1 cm in length. Six simultaneous scalar ECG leads were recorded prior to the first incision and following each incision. The QRS duration was then measured and related to the length of the ventriculotomy.Following the right ventriculotomy, 12 of the 15 patients developed an RBBB pattern; the remaining three did not. In all cases, the total increase in QRS duration occurred during one specific incision of the right ventricular free wall and was not related to the total length of the ventriculotomy or to the sequence of the incisions. The site at which incision of the right ventricle caused the RBBB pattern was located at between 40 to 73% of the distance between the pulmonary artery annulus and the inferior border of the heart in nine patients; in three patients the site was higher on the right ventricular free wall.Our results explain why some patients who had a right ventriculotomy during open heart surgery do not develop an RBBB pattern on the scalar ECG. Also, since no relation was found between the length of the incision and the QRS duration, our results suggest that the ventriculotomy-induced RBBB pattern is unlikely to be due to disruption of a continuous Purkinje network but is probably due to disruption of a distal branch or branches of the right bundle.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference31 articles.

1. Anatomical variations in atrioventricular conduction system with reference to ventricular septal defects;Br Heart J,1972

2. Surgical injury to the conduction system in ventricular septal defect

3. The electrocardiogram in open heart surgery: Disturbances in right ventricular conduction;J Thorac Cardiovasc Surg,1958

4. Right bundle branch block following open heart surgery

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3