This anatomical study demonstrates the high variability of the proximal left bundle branch, challenging the simplified concept of a discrete bifascicular left bundle system.
The relationships among the His bundle, the origin of both bundle branches, and the interventricular (IV) septum were examined histologically in 32 human hearts, and the entire bundle branch systems were delineated in 13 of these. The His bundle in five hearts traversed the right IV septal crest, and the LBB origin was a very narrow stem (maximum 1.5 mm in cross-section) crossing from right to left through the inferior margin of the membranous septum. Proximal LBB anatomy was extremely variable, demonstrating multiple fiber groups which fanned out over the entire left septal surface. The LBB did not divide into two discrete divisions without multiple interconnections. The RBB formed an obtuse angle with the His bundle in 27 of 32 hearts. In those five hearts with "right-sided His bundles," the right bundle branch was a direct continuation. The clinical, electrophysiologic, and electrocardiographic implications of these anatomical observations are discussed.
Massing et al. (1976) studied this question.