Intraventricular conduction delay causes

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Intraventricular conduction delay Microchapters



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]


Intraventricular conduction delays(IVCDs) refers to abnormalities in the intraventricular propagation of supraventricular impulses. These abnormalities can be due to pathology in either the left bundle of His or its fascicular branches or the right bundle of His or its combination resulting in changes to the QRS complex. Causes can be classified based upon the site of pathology in the ventricular conduction system as well as the associated medical condition.


Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Left Bundle Branch Block Causes

LBBB usually appears in patients with underlying heart disease such as hypertensive heart disease, valvular heart disease, cardiomyopathy etc. Most patients with left ventricular hypertrophy and coronary artery disease of LAD show left bundle branch block (LBBB) conduction delay pattern on the surface electrocardiogram (ECG).

Right Bundle Branch Block Causes

RBBB is a common finding in the general population when compared to LBBB, and many persons with RBBB have no clinical evidence of underlying heart disease. Right side valvular heart diseases, COPD, coronary artery disease show right bundle branch block (RBBB) conduction delay pattern on the surface electrocardiogram (ECG).

Left Anterior Fascicular Block Causes

Isolated LAFB is very common when compared to LPFB. This conduction delay pattern on ECG may be seen with hypertension, aortic valve disease, coronary disease of LAD artery septal branch and sometimes in general population without identifiable cause.

Left Posterior Fascicular Block Causes

Isolated LPFB is very rare when compared to LAFB. Most often it occurs with RBBB in patients with chronic lung disease and right ventricular hypertrophy.

Left Median Fascicular Block Causes

Isolate LMFB that occurs due to pathology involving interventricular septum is rare. A number of neuromuscular diseases are associated with fascicular block.

Multifascicular Block Causes

Multifascicular block refers to conduction delay or block in more than one of the structural components of the specialized conduction system—that is, the left bundle branch, the left anterior and posterior fascicles of the left bundle branch, and the right bundle branch. Conduction delay in any two fascicles is termed bifascicular block, and delay in all three fascicles is termed trifascicular block. Causes of multifascicular block are those which cause individual blocks and the most common are LVH, RVH and coronary heart disease.


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