Histological examination of patients with RBBB and left axis deviation revealed lesions in the right bundle branch and divisions of the left bundle branch, correlating with ECG findings.
Case reports of conduction lesions in bifascicular block warrant no practice change; leaves open prognostic value in larger cohorts.
The conduction system was examined histologically in three cases whose electrocardiograms showed right bundle branch block and left axis deviation with or without PR prolongation. In two cases histological lesions were found in the right bundle branch and anterior division of the left bundle branch. In the third case histological lesions were found in the right bundle branch and anterior and posterior divisions of the left bundle branch. This case sufferred an Adams-Stokes attack. In the two patients with right bundle branch block and left axis deviation with PR prolongation, the PR prolongation was attributed to delay in atrioventricular node or His bundle in one case and to delay in left bundle branch in the other.
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Minoru Ohmae (1977) studied this question.