Current Concepts of Hemiblocks

  • Calvin L. Weisberger
  • Edward K. Chung


For many years the intraventricular conduction system had been considered as only two branches consisting of right and left bundle branches. Right bundle branch block and left bundle branch block have been known as distinct electrocardiographic entities for decades. Various investigators recognized and described other forms of intraventricular conduction block and coined various names for them (12). There were, however, no clearcut anatomic., physiologic., and electrocardiographic descrip tions of these various electrocardiographic entities. They, therefore, existed as curiosities without implying useful information for the clinician. In 1967, Rosenbaum and colleagues published their text Los Hemibloqueos, which clearly documented, described and demonstrated significance for electrocardiographic patterns signifying blocks in subdivision of the left bundle branch system. These included and superseded to a great extent many of the previously described, partial intraventricular conduction blocks. Since their publication the term, blhemiocks has become a unique and popular electrocardiographic term. There still exists a debate over (a) the real anatomic nature of the intraventricular conduction system and (b) over the true clinical implications of the various forms of hemiblocks. In this Chapter, the purpose is to explore what is known about hemiblocks and what implications this knowledge holds for the clinicians.


Left Bundle Branch Block Versus Node Right Bundle Branch Block Versus Block Cardiac Conduction System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chung, E. K. Electrocardiography: Practical Applications with Vectorial Principles. Hagerstown, Harper and Row, 1974.Google Scholar
  2. 2.
    Principles of Cardiac Arrhythmias. Baltimore, Williams and Wilkins Co., 1971.Google Scholar
  3. 3.
    Demoulin, J. C. and Kulbertus, H. E. Histopathologic examination of concept of left hemiblock. Am. Heart J., 34:807–814, 1972.Google Scholar
  4. 4.
    Depasquale, N. P. and Bruno, M. S. Natural history of combined right bundle branch block and left anterior hemiblock. Am. J. Med., 54:297, 1973.PubMedCrossRefGoogle Scholar
  5. 5.
    Durrer, D., VanDam, R. T., Freud, G. E., Janse, M. J., Meijler, F. L., and Arzbaecher, R. C. Total excitation of the isolated human heart. Circulation, 41:899, 1970.PubMedCrossRefGoogle Scholar
  6. 6.
    Grant, R. P. Left axis deviation: an electrocardiographic pathologic correlation study. Circulation, 14:233, 1956.PubMedCrossRefGoogle Scholar
  7. 7.
    James, T. N. The specialized conducting tissue of the atria. In Dreifus, L. S. and Likoff, W. eds. Mechanism and Therapy of Cardiac Arrhythmias. New York, Grune and Stratton, 1971.Google Scholar
  8. 8.
    Kulbertus, H. E. The magnitude of risk of developing complete heart block in patients with LAD-RBBB. Am. Heart J., 86:278,1973.Google Scholar
  9. 9.
    Lazzara, R., Yeh, B. K., and Samet, P. Functional anatomy of the canine left bundle branch. Am. J. Cardiol., 33:623, 1974.PubMedCrossRefGoogle Scholar
  10. 10.
    Lev, M., Unzer, P. N., Rosen, K. M., and Bharate, K. The anatomic substrate of complete left bundle branch block. Circulation, 50:479, 1974.PubMedCrossRefGoogle Scholar
  11. 11.
    Lie, K. I., Wellens, H. J., Schulenberg, R. M., Becker, A. E., and Durrer, D. Factors influencing prognosis of bundle branch block complicating acute antero-septal infarction. The value of His bundle recordings. Circulation, 50:935, 1974.Google Scholar
  12. 12.
    Pryor, R. and Blount, S. G. The clinical significance of true left axis deviation. Am. Heart J., 72:391, 1966.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosenbaum, M. B., Elizari, M. V., Lazzari, J. O., Kretz, A., and DaRuos, H. A. The clinical causes and mechanisms of intraventricular conduction disturbances. In Schlant, R. C. and Hurst, J. W. eds. Advances in Electrocardiography. New York, Grune and Stratton, 1972.Google Scholar
  14. 14.
    Rosenbaum, M. B., Elizari, M. V., and Lazzari, J. O. The Hemiblocks, Oldsman, Fla., Tampa Tracings, 1970.Google Scholar
  15. 15.
    Truex, R. C. Comparative anatomy and functional considerations of the cardiac conduction system. In De Carravello, A. P. ed. Specialized Tissues of The Heart. New York, American Elsevier Publishing Co., 1962.Google Scholar
  16. 16.
    Varriale, P. and Kennedy, R. J. Right bundle branch block and left posterior fascicular block. Am. J. Cardiol., 29:459, 1972.PubMedCrossRefGoogle Scholar
  17. 17.
    Weisberger, C. L. Unpublished data.Google Scholar
  18. 18.
    Scariato, A., Kasparian, H., Duca, P., Gottlieb, R., and Brest, A. N. Coronary angiographic significance of left anterior hemiblock. Unpublished data.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1976

Authors and Affiliations

  • Calvin L. Weisberger
  • Edward K. Chung

There are no affiliations available

Personalised recommendations