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Recognition, Natural History, and Therapeutic Implications

Martin A. Alpert, MD; Greg C. Flaker, MD

Arch Intern Med. 1984;144(4):799-802.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

The clinician is frequently confronted with a difficult therapeutic decision when patients with chronic bundlebranch block have syncope or other transient neurologic symptoms. The decision of whether and when to implant a permanent pacemaker in such patients is based on a number of clinical and electrophysiologic variables. We provide herein an anatomic and ECG basis for the diagnosis of these conduction disturbances, discuss their natural history with special reference to cardiac electrophysiologic subsets, and offer a rational approach to management.

ANATOMIC CONSIDERATIONS

After emerging from the atrioventricular (AV) node, the cablelike bundle of His penetrates the membranous interventricular septum and courses inferiorly for approximately 15 mm, then bifurcates to form the right and left bundle branches.¹ The right bundle branch traverses the right side of the interventricular septum. Its proximal branches terminate at the right ventricular apex. Its peripheral ramifications spread over the right side of the muscular interventricular . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Medicine, University of Missouri School of Medicine, Columbia.

Footnotes
Accepted for publication Aug 23, 1983.

Dr Alpert is a Teaching and Research Scholar of the American College of Physicians.

Reprint requests to Division of Cardiology, Room 1E-65, University of Missouri, Health Sciences Center, 1 Hospital Drive, Columbia, MO 65212 (Dr Alpert).

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