Key result
Evidence confirms the left bundle branch divides into three fascicles, establishing a tetrafascicular conduction system.
Why the study?
The existence and characteristics of a tetrafascicular intraventricular conduction system, including left septal fascicular block, remain debatable and not universally accepted.
This review supports the tetrafascicular nature of the intraventricular conduction system and the clinical existence of left septal fascicular block.
Supports tetrafascicular conduction model for ECG interpretation; leaves open clinical relevance of left septal fascicular block.
The existence of a tetrafascicular intraventricular conduction system remains debatable. A consensus statement ended up with some discrepancies and, despite agreeing on the possible existence of an anatomical left septal fascicle, the electrocardiographic and vectorcardiographic characteristics of left septal fascicular block (LSFB) were not universally accepted. The most important criteria requested to confirm the existence of LSFB is its intermittent nature. So far, our group has published cases of transient ischemia-induced LSFB and phase 4 or bradycardia-dependent LSFB. Finally, anatomical, anatomopathological, histological, histopathological, electrocardiographic, vectorcardiographic, body surface potential mapping, and electrophysiology studies support the fact that the left bundle branch divides into three fascicles or a "fan-like interconnected network."
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Pérez‐Riera et al. (2018) conducted a review in Left septal fascicular block. Anatomical, electrocardiographic, and electrophysiology studies support the concept that the left bundle branch divides into three fascicles, confirming a tetrafascicular intraventricular conduction system.
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