Left anterior fascicular block
| Left anterior fascicular block | |
|---|---|
| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | I44.4 |
| Patient UK | Left anterior fascicular block |
Left anterior fascicular block, sometimes abbreviated LAFB, is a cardiac condition,[1][2] distinguished from left bundle branch block.
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.
Contents
Characteristics
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.
Criteria
- Abnormal left axis deviation[3] (usually between –45° and –60°)[4]
- qR pattern (small q, tall R) in the lateral limb leads I and aVL
- rS pattern (small r, deep S) in the inferior leads II, III, and aVF
- Delayed intrinsicoid deflection in lead aVL (> 0.045 s)
LAFB cannot be diagnosed when a prior inferior wall myocardial infarction (IMI) is evident on the ECG. IMI can also cause extreme left-axis deviation, but will manifest with Q-waves in the inferior leads II, III, and aVF. By contrast, QRS complexes in the inferior leads should begin with r-waves in LAFB.
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. _____
Clinical Significance
- 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.
