Left anterior fascicular block
|Left anterior fascicular block|
|Classification and external resources|
It is caused by only the anterior half of the left bundle branch being defective. It is manifested on the ECG by left axis deviation.
It is much more common than left posterior fascicular block.
Normal activation of the left ventricle proceeds down the left bundle branch, which consist of three fascicles, the left anterior fascicle, the left posterior fascicle, and the septal fascicle. The posterior fascicle supplies the posterior and inferoposterior walls of the left ventricle, the anterior fascicle supplies the upper and anterior parts of the left ventricle and the septal fascicle supplies the septal wall with innervation. Left Anterior Fascicular Block (LAFB), which is also known as Left Anterior Hemiblock (LAHB), occurs when a cardiac impulse spreads first through the left posterior fascicle, causing a delay in activation of the anterior and upper parts of the left ventricle. Although there is a delay or block in activation of the left anterior fascicle there is still preservation of initial left to right septal activation as well as preservation of the inferior activation of the left ventricle (preservation of septal Q waves in I and aVL and predominantly negative QRS complex in leads II, III, and aVF). The delayed and unopposed activation of the remainder of the left ventricle now results in a shift in the QRS axis leftward and superiorly, causing marked left axis deviation. This delayed activation also results in a widening of the QRS complex, although not to the extent of a complete LBBB.
- Abnormal left axis deviation (usually between –45° and –60°)
- qR complex in the lateral limb leads (I and aVL)
- rS pattern in the inferior leads (II, III, and aVF)
- Delayed intrinsicoid deflection in lead aVL (> 0.045 s)
It is important not to call LAFB in the setting of a prior inferior wall myocardial infarction which may also demonstrate left axis deviation due to the initial forces (Q wave in a Qr complex) in leads II, III, and aVF.
Effects of LAFB on Diagnosing Infarctions and Left Ventricular Hypertrophy
LAHB may be a cause of poor R wave progression across the precordium causing a pseudoinfarction pattern mimicking an anteroseptal infarction. It also makes the electrocardiographic diagnosis of LVH more complicated, because both may cause a large R wave in lead aVL. Therefore to call LVH on an EKG in the setting of an LAHB you should see the presence of a “strain” pattern when you are relying on limb lead criteria to diagnose LVH. _____
- It can be seen in approximately 4% of cases of acute myocardial infarction
- It is the most common type of intraventricular conduction defect seen in acute anterior myocardial infarction, and the left anterior descending artery is usually the culprit vessel.
- It can be seen with acute inferior wall myocardial infarction.
- It is also associated with hypertensive heart disease, aortic valvular disease, cardiomyopathies, and degenerative fibrotic disease of the cardiac skeleton.
- Rebuzzi AG, Loperfido F, Biasucci LM (July 1985). "Transient Q waves followed by left anterior fascicular block during exercise". Br Heart J 54 (1): 107–9. doi:10.1136/hrt.54.1.107. PMC 481860. PMID 4015909.
- Chandrashekhar Y, Kalita HC, Anand IS (January 1991). "Left anterior fascicular block: an ischaemic response during treadmill testing". Br Heart J 65 (1): 51–2. doi:10.1136/hrt.65.1.51. PMC 1024464. PMID 1899584.
- Horwitz S, Lupi E, Hayes J, Frishman W, Cárdenas M, Killip T (September 1975). "Electrocardiographic criteria for the diagnosis of left anterior fascicular block. Left axis deviation and delayed intraventricular conduction". Chest 68 (3): 317–20. doi:10.1378/chest.68.3.317. PMID 1157535.
- "Conduction Blocks 2006 KCUMB". Retrieved 2009-01-20.