Skip to main content
SpringerLink
Log in

New concepts of heart block

  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

Summary

Histo-Pathological studies have demonstrated the essential focal nature of AV conduction disturbances, but current clinical concepts of heart block, derived from the scalar electrocardiogram, give little or no information as to the precise site within the conducting system where impulses are delayed or blocked. The His bundle electrogram resolves the complex P-R interval of scalar tracings into its various components. It can be used therefore to define the precise location and degree of block and this information permits detailed analysis of the underlying mechanisms to be attempted. New concepts of heart block based on measurements of the His bundle electrogram, are presented, in which heart block is classified into four main groups, identified by the site within the conducting system, where delay or block of impulses occurs. These are, (1) within the internodal atrial tracts, (Group I), (2) in the atrio-ventricular node, (Group II), and (3) within the fibres of the His-Purkinje system, (Group III). Cases with more than one site of disturbed conduction, are included in Group IV, and they can be identified by the His bundle electrogram alone. It is suggested that this new knowledge has important diagnostic and therapeutic applications, and these are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bachmann, G. 1941. The significance of splitting of the P-wave in the electrocardiogram. Ann. Intern. Med. 14: 1702.

    Google Scholar 

  • Bekheit, S., Murtagh, J. Q., Morton, P., and Fletcher, E. 1971. Measurements of Sinus impulse conduction from electrogram of bundle of His. Brit. Heart J. 33: 719.

    Article  PubMed  CAS  Google Scholar 

  • Bekheit, S., Murtagh, J. G., Morton, P., Fletcher, E. 1972. Studies of Heart block with the His bundle electrogram. Brit. Heart J. 34: 717.

    Article  PubMed  CAS  Google Scholar 

  • Davies, M. and Harris, A. 1969. Pathological basis of primary heart block. Brit. Heart J. 31: 219.

    Article  PubMed  CAS  Google Scholar 

  • Dreifus, L. S., Watanabe, Y., Hiat, R., and Kimbiri, S. 1971. Atrioventricular Block. Amer. J. Cardiology 38, 4: 371.

    Article  Google Scholar 

  • Hay, J. 1906. Bradycardia and Cardiac arrhythmia produced by depression of certain functions of the heart. Lancet i, 139.

    Article  Google Scholar 

  • James, T. N. 1963. The connecting pathways between the sinus node and the A-V node and between the right and left atrium in the human heart. Amer. Heart J. 66: 498.

    Article  PubMed  CAS  Google Scholar 

  • Lenegre, J. 1964. Etiology and pathology of bilateral bundle branch block in relation to complete heart block. Progress Cardiovascular Disease, 6: 409.

    Article  CAS  Google Scholar 

  • Lev, M. 1964. Anatomic basis for atrioventricular block. Amer. J. Med. 37: 742.

    Article  PubMed  CAS  Google Scholar 

  • Mobitz, W. 1928. Uber den partiellen Herzblock. Z Klin Med. 107: 449.

    Google Scholar 

  • Narula, O. S., Cohen, L. S., Samet, P., Lister, J. W. 1970. Scerlag, B., Hildner, F. J. Loca lisation of A-V conduction defects in man by recording of the His bundle electrograms Amer. J. Cardiol. 25: 228.

    Article  PubMed  CAS  Google Scholar 

  • Narula, O. S., Runge, M. and Samet, P. 1972. Twenty-first Annual Scientific Session, American College of Cardiology.

  • Narula, O. S., Scerlag, B. J., Javier, R. P., Hildner, F. J. and Samet, P. 1970. Analysis of the A-V conduction defect in complete heart block utilising His bundle electrograms. Circulation, 41: 437.

    PubMed  CAS  Google Scholar 

  • Rosenbaum, M. B., Elizari, M. V. and Lazzari, J. O. 1968. Los Hemibloqueos. Buenos Aires Ed. Paidos.

  • Scherf, D. and Cohen, J. 1964. The atrioventricular node and selected cardiac arrhythmias. Grune and Strutton, New York.

    Google Scholar 

  • Scherf, D. and Shookhoff, C. 1925. Reizleitungs-Storungen inn bundel. 1. Wein Archi, inn. Med. 10: 97.

    Google Scholar 

  • Scherlag, B. J., Lau, S. H., Helfant, R. H., Stein, E., Berkowitz, W. and Damato, A. N. 1969. Circulation, 39: 13.

    PubMed  CAS  Google Scholar 

  • Thorel, C. 1910. Uber den aufbau des sinusknotens und seine verbindug mit de cava superior und der Wenckebach schen bundlen. Muchen Med. Wescher. 57: 183.

    Google Scholar 

  • Wenckebach, K. F. 1899. Zur analyse des urregelmassigeu pulses. Z Klin. Med., 37: 475.

    Google Scholar 

  • Wenckebach, K. F. 1963. Beitrage zur Kenntuis der menschlichen hertztatigkeit. Arch. Anat. physiol. Abth., 297, 1906.

    Google Scholar 

  • Zoob, M. and Smith, K. S. 1963. The aetiology of complete heart block. Brit. med. J. ii, 149.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Cardiovascular Unit, Belfast City Hospital, Northern Ireland

    S. Bekheit, J. G. Murtagh, P. Morton & E. Fletcher

Authors
  1. S. Bekheit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. G. Murtagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Morton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bekheit, S., Murtagh, J.G., Morton, P. et al. New concepts of heart block. Ir J Med Sci 142, 329–341 (1973). https://doi.org/10.1007/BF02950030

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02950030

Keywords

Search

Navigation