PMID: 1383984Sep 1, 1992Paper

Supernormal conduction in the left bundle branch unmasked by the linking phenomenon

Pacing and Clinical Electrophysiology : PACE
F LuzzaI M Scimone

Abstract

This presentation reflects a case of phase-3 left bundle branch block (LBBB). Analysis reveals that relatively early QRS complexes are wide, whereas beats occurring later than a critical time are narrow. There are, however, two unexpected phenomena: (1) an overlap occurs between the range of R-R intervals resulting in normal intraventricular conduction and the range of R-R intervals resulting in LBBB pattern. Complexes that follow a wide beat are often wide although they are associated with relatively long R-R intervals, whereas complexes that follow a normal beat tend to be normal even after relatively short R-R cycles. This is due to concealed retrograde penetration of the bundle branch that is blocked in anterograde direction (the so-called linking phenomenon). (2) Some early supraventricular impulses, paradoxically, resulted in normal intraventricular conduction. The phenomenon is a manifestation of supernormal LBB conduction, and only occurs following a wide QRS complex associated with retrograde activation of the LBB. The linking phenomenon reveals or unmasks the supernormal phase of LBB conduction. Following a retrograde and delayed activation of the LBB, the refractory period of the bundle branch is postponed, in such a...Continue Reading

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Citations

May 11, 2004·Journal of Electrocardiology·Vincenzo CarboneMaria Pia Calabrò
Jun 27, 2015·International Journal of Cardiology·Francesco LuzzaPietro Pugliatti
May 13, 2015·International Journal of Cardiology·Francesco LuzzaPietro Pugliatti
Jul 19, 2011·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Rituparna S ShindeG Oreto
Jan 3, 2006·Journal of Electrocardiology·Francesco LuzzaG Oreto
Sep 24, 2013·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Vincenzo CarboneG Oreto
Apr 1, 1994·Journal of Cardiovascular Electrophysiology·G OretoH J Wellens
May 30, 2013·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Sukhvinder Singh

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