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Bundle Branch and Fascicular Block: Understanding Conduction System Disorders

Learn about the physiology and pathophysiology of bundle branch and fascicular blocks. Explore the blood supply to the electrical conduction system and distinguish between intact viable and non-viable conduction pathways.

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Bundle Branch and Fascicular Block: Understanding Conduction System Disorders

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  1. Bundle Branch and Fascicular Block Chapter 13 Robert J. Huszar, MD Instructor Patricia L. Thomas, MBA, RCIS

  2. Outline • Student Demonstration of Axis • Electrical Conduction system and Blood supply • Physiology of the Electrical Conduction System • Pathophysiology of the Bundle Branch and Fascicular Blocks • Right Bundle Branch Block • QRS Complexes • Left Bundle Branch Block

  3. A&P of the Electrical Conduction System • RBB runs down the right side of the IS to conduct the electrical impulses to the RV. • LBB short, thick, flat (main stem) conducts the electrical impulses to IS & LV. It is divided into two parts: • LAF conducts electrical impulses from the main stem to the anterior and lateral walls of LV. • LPF conducts electrical impulses to the posterior wall of the LV.

  4. Blood Supply to the Electrical Conduction System • Anterior two thirds of the interventricular septum is supplied by the left anterior descending CA. • Posterior third of the septum is supplied by the posterior descending CA. • AV Node and Proximal Bundle of His is the AV node artery. • Distal Bundle of His, RBB, Main stem of LBB and Lt Anterior Fascicle are supplied by the LAD septals. • Left Posterior Fascicle is supplied by the LAD and PDA.

  5. Intact viable vs. Not Intact or viable • IVIS-is capable of conducting an electrical impulse and depolarizing from left to right producing and initial small q or r wave in the QRS complex in V1,V2 & V6. Resulting synchronous depolarization with the smaller RV buried in that generated by the LV. • NVIS- results because of some form of Heart Disease, (MI) is unable to conduct an electrical impulse and depolarize normally ( absence of a q or r wave)

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