Historical and experimental evidence suggests that complete atrioventricular block is frequently caused by bilateral bundle-branch interruption rather than a block above the bifurcation.
This historical review highlights that complete A-V block is frequently caused by bilateral bundle-branch block rather than a block above the bifurcation.
The introduction of the artificial electrical pace- maker for the treatment of patients with complete A-V block has been accompanied by renewed inter- est in the pathogenesis of this disorder. It has been considered that most cases of complete block are due to organic or functional lesions either in the A-V node or in the common A-V bundle. Barker and Hirschfelder in 1909 and later Eppinger and Rothberger (1910) demonstrated experimentally that section of both bundle-branches or of the bun- dle of His could produce a complete A-V block. Wilson and Herrmann in 1921 studied this problem again and concluded that complete block could be due to an interruption of both bundle-branches. They also postulated that in complete block, if the ventricular complexes were of an aberrant type, bilateral bundle-branch block must exist, whereas if the ventricular complexes were of normal contour the interruption must have been above the bifurca- tion. Yater, Cornell, and Claytor in 1936 published a review of the published reports of 48 patients with pathologically proven complete A-V block due to bilateral bundle-branch block. On the basis of their studies, they concluded that a large number of patients with complete A-V block would have an interruption of both bundle-branches rather than a block above the bifurcation.
Javier López (Mon,) conducted a review in Complete atrioventricular block. Historical and experimental evidence suggests that complete atrioventricular block is frequently caused by bilateral bundle-branch interruption rather than a block above the bifurcation.