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Bradycardia
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
The term, trifascicular block is a confusing description often applied loosely to describe the electrocardiographic (ECG) pattern of prolonged PR interval in association with bifascicular block. In true sense, trifascicular block is present when bifascicular block is associated with a prolonged His-Ventricular (HV) interval. A prolonged PR interval does not identify patients who have prolonged HV intervals in such cases. In fact, nearly half of patients with bifascicular block and prolonged PR intervals have prolongation of the Atrial-His (AH) interval (i.e., AV nodal conduction time). A strict definition of trifascicular block is block documented in all three fascicles, whether simultaneously or at different times. Thus the term, trifascicular block should be applied only to the ECG patterns of alternating RBBB and LBBB or RBBB with intermittent LAFB and LPFB. These patients are at high risk for progression to sudden development of complete AV block and have a class I indications for permanent pacing, even in asymptomatic individuals.
Bradyarrhythmias
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
This is defined as the combination of RBBB, left axis deviation or LBBB and right axis deviation. If there is also first-degree heart block in the context of bifascicular block, it is termed trifascicular block.
Cardiovascular system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Redmond P Tully, Robert Turner
Bifascicular block – RBBB and L anterior or posterior hemiblock. May progress to trifascicular block or complete heart block. No specific management is required unless the block progresses at which point a pacemaker should be considered.
Looking back on 15 years of ultrasound-guided alcohol septal ablation for hypertrophic obstructive cardiomyopathy
Published in Acta Cardiologica, 2020
I. Vermaete, K. Dujardin, F. Stammen
Conversely, new onset or worsening of previous conduction disturbances were numerous (65%), with third-degree atrioventricular block (CHB) necessitating early postprocedural permanent pacemaker implantation in 4 out of 8 patients (15%), of whom 2 patients had a prior conduction delay (complete RBBB and LBBB). Eight other patients acutely developed RBBB, besides a first-degree AV block, LAFB or left posterior fascicular block in 3 patients, resulting in various bi- and trifascicular blocks albeit without higher degree AV blocks. De novo LBBB occurred only once, as did non-specific intraventricular conduction defect with new first-degree AV block. Of note, 1 patient with a preprocedural trifascicular block required permanent pacemaker implantation not earlier than 12 years after ASA.
Transcatheter aortic valve replacement and cardiac conduction
Published in Expert Review of Cardiovascular Therapy, 2019
Satya Shreenivas, Edward Schloss, Joseph Choo, Ian Sarembock, Scott Lilly, Dean Kereiakes
In the absence of clear guidelines, individual centers have developed their own algorithms for managing conduction abnormalities and this has resulted in variable timing and criteria for PPM implantation. In a retrospective analysis of PPM implantation in the REPRISE III trial, 77.1% of patients underwent PPM for third-degree AV block or Mobitz Type 2 heart block while 8% of patients had an unknown indication and 7.6% of patients had bifascicular or trifascicular block (not an indication for PPM based on either the ESC or AHA/ACC guidelines) (Figure 4) [55]. Similarly, in an analysis of 2,599 patients in the PARTNER trial and registry, 79% of PPM were implanted for third-degree AV block or Mobitz Type 2 heart block, while the rest were implanted for other reasons [54]. The push for early PPM in the U.S. population is likely driven by high cost for hospitalization, the inherent risk for long hospitalization of an elderly cohort with significant frailty and multiple comorbidities, and existing reimbursement models.
Prognostic impact of bundle branch blocks in patients with ST-segment elevation myocardial infarction
Published in Acta Cardiologica, 2021
Flora Ozkalayci, Erdem Turkyilmaz, Bernas Altıntaş, Ozgur Yasar Akbal, Ali Karagoz, Can Yucel Karabay, İbrahim Halil Tanboga, Vecih Oduncu
Three thousand fifty-seven STEMI patients underwent pPCI were retrospectively analysed (mean age was 58.7 ± 11.9, male gender was 77.75%). Those patients with BBB in their ECG on admission were re-evaluated for their prior ECG. Among these patients 134 (4.4%) had LBBB, and 67 (2.2%) had RBBB, in whom BBB onset was classified into three subgroups. Patients with left anterior fascicular hemi block patients and posterior fascicular hemi block were enrolled to no-BBB group. Patients with trifascicular block, second degree AV block and third degree AV block were excluded. Those patients with cardiopulmonary arrest in admission were excluded.