What Intracardiac Tracings Have Taught Us About Left Bundle Branch Block


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Cardiac Electrophysiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eppinger H.
        • Rothberger C.J.
        Zur analyse des elektrokardiogramms.
        Wien Klin Wochenschr. 1909; 22: 8
        • Flowers N.C.
        Left bundle branch block: a continuously evolving concept.
        J Am Coll Cardiol. 1987; 9: 684-697
        • Carter E.P.
        Clinical observations on defective conduction in the branches of the auriculoventricular bundle: a report of twenty-two cases, in which aberrant beats were obtained.
        Arch Intern Med. 1914; XIII: 803-840
        • Braun-Menendez
        • Solari L.A.
        Ventricular asynchronism in bundle branch block.
        Arch Intern Med. 1939; 63: 830-847
        • Surawicz B.
        • Childers R.
        • Deal B.J.
        • et al.
        AHA/ACCF/HRS Recommendations for the Standardization and interpretation of the electrocardiogram: Part III: intraventricular conduction disturbances A Scientific Statement from the American heart association Electrocardiography and Arrhythmias Committee, Council on clinical Cardiology; the American College of Cardiology Foundation; and the heart Rhythm Society Endorsed by the international Society for Computerized Electrocardiology.
        J Am Coll Cardiol. 2009; 53: 976-981
      1. ACC/AHA/HRS guideline on the Evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American heart association Task Force on clinical practice guidelines and the heart Rhythm Society | Journal of the American College of Cardiology.
        (Available at:) (Accessed July 30, 2021)
        • Willems J.L.
        • Robles de M.E.O.
        • Bernard R.
        • et al.
        Criteria for intraventricular conduction disturbances and pre-excitation.
        J Am Coll Cardiol. 1985; 5: 1261-1275
        • Scott R.C.
        Left bundle branch block—a clinical assessment Part I.
        Am Heart J. 1965; 70: 535-566
        • Wilson F.N.
        Concerning the form of the QRS deflections of the electrocardiogram in bundle branch block.
        J Mt Sinai Hosp NY. 1941; 8: 1110
        • Wilson F.N.
        • Johnston F.D.
        • Rosenbaum F.F.
        • et al.
        The precordial electrocardiogram.
        Am Heart J. 1944; 27: 19-85
        • ROSENMAN R.H.
        • PICK A.
        • KATZ L.N.
        Intraventricular block: review of the Literature.
        Arch Intern Med. 1950; 86: 196-232
        • Members A.F.
        • Brignole M.
        • Auricchio A.
        • et al.
        2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapyThe Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).
        Eur Heart J. 2013; 34: 2281-2329
        • Zareba W.
        • Klein H.
        • Cygankiewicz I.
        • et al.
        Effectiveness of cardiac resynchronization therapy by QRS morphology in the Multicenter Automatic defibrillator implantation trial–cardiac resynchronization therapy (MADIT-CRT).
        Circulation. 2011; 123: 1061-1072
        • Ruschitzka F.
        • Abraham W.T.
        • Singh J.P.
        • et al.
        Cardiac-resynchronization therapy in heart failure with a narrow QRS complex.
        N Engl J Med. 2013; 369: 1395-1405
        • Strauss D.G.
        • Selvester R.H.
        • Wagner G.S.
        Defining left bundle branch block in the Era of cardiac resynchronization therapy.
        Am J Cardiol. 2011; 107: 927-934
        • Grant R.P.
        • Dodge H.T.
        Mechanisms of QRS complex prolongation in man: left ventricular conduction disturbances.
        Am J Med. 1956; 20: 834-852
        • Vassallo J.A.
        • Cassidy D.M.
        • Marchlinski F.E.
        • et al.
        Endocardial activation of left bundle branch block.
        Circulation. 1984; 69: 914-923
        • Auricchio A.
        • Fantoni C.
        • Regoli F.
        • et al.
        Characterization of left ventricular activation in patients with heart Failure and left bundle-branch block.
        Circulation. 2004; 109: 1133-1139
        • Strauss D.G.
        • Selvester R.H.
        The QRS complex—a biomarker that “images” the heart: QRS scores to quantify myocardial scar in the presence of normal and abnormal ventricular conduction.
        J Electrocardiol. 2009; 42: 85-96
        • Jastrzębski M.
        • Kukla P.
        • Kisiel R.
        • et al.
        Comparison of four LBBB definitions for predicting mortality in patients receiving cardiac resynchronization therapy.
        Ann Noninvasive Electrocardiol. 2018; 23: e12563
        • Caputo M.L.
        • van Stipdonk A.
        • Illner A.
        • et al.
        The definition of left bundle branch block influences the response to cardiac resynchronization therapy.
        Int J Cardiol. 2018; 269: 165-169
        • van Stipdonk A.M.W.
        • Hoogland R.
        • ter Horst H.I.
        • et al.
        Evaluating Electrocardiography-based identification of cardiac resynchronization therapy responders beyond current left bundle branch block definitions.
        JACC Clin Electrophysiol. 2020; 6: 193-203
        • Upadhyay G.A.
        • Cherian T.
        • Shatz D.Y.
        • et al.
        Intracardiac Delineation of septal conduction in left bundle-branch block patterns.
        Circulation. 2019; 139: 1876-1888
        • Vijayaraman P.
        • Herweg B.
        • Ellenbogen K.A.
        • et al.
        His-optimized cardiac resynchronization therapy to Maximize electrical resynchronization.
        Circ Arrhythm Electrophysiol. 2019; 12: e006934
        • Zweerink A.
        • Zubarev S.
        • Bakelants E.
        • et al.
        His-optimized cardiac resynchronization therapy with ventricular Fusion pacing for electrical resynchronization in heart Failure.
        JACC Clin Electrophysiol. 2021; 7: 881-892
        • Jastrzębski M.
        • Moskal P.
        • Huybrechts W.
        • et al.
        Left bundle branch–optimized cardiac resynchronization therapy (LOT-CRT): results from an international LBBAP collaborative study group.
        Heart Rhythm. 2021;
        • Tung R.
        • Upadhyay G.A.
        Defining left bundle branch block patterns in cardiac resynchronisation therapy: a return to His bundle recordings.
        Arrhythmia Electrophysiol Rev. 2020; 9: 28-33
        • van Stipdonk A.M.W.
        • Vanbelle S.
        • ter Horst I.A.H.
        • et al.
        Large variability in clinical judgement and definitions of left bundle branch block to identify candidates for cardiac resynchronisation therapy.
        Int J Cardiol. 2019; 286: 61-65
        • Jurak P.
        • Halamek J.
        • Meluzin J.
        • et al.
        Ventricular dyssynchrony assessment using ultra-high frequency ECG technique.
        J Interv Card Electrophysiol. 2017; 49: 245-254
        • Jurak P.
        • Curila K.
        • Leinveber P.
        • et al.
        Novel ultra-high-frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization.
        J Cardiovasc Electrophysiol. 2020; 31: 300-307
        • Lustgarten D.L.
        • Calame S.
        • Crespo E.M.
        • et al.
        Electrical resynchronization induced by direct His-bundle pacing.
        Heart Rhythm. 2010; 7: 15-21
        • Lustgarten D.L.
        • Crespo E.M.
        • Arkhipova-Jenkins I.
        • et al.
        His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison.
        Heart Rhythm. 2015; 12: 1548-1557
        • Ajijola O.A.
        • Upadhyay G.A.
        • Macias C.
        • et al.
        Permanent His-bundle pacing for cardiac resynchronization therapy: Initial feasibility study in lieu of left ventricular lead.
        Heart Rhythm. 2017; 14: 1353-1361
        • Upadhyay G.A.
        • Vijayaraman P.
        • Nayak H.M.
        • et al.
        His corrective pacing or biventricular pacing for cardiac resynchronization in heart Failure.
        J Am Coll Cardiol. 2019; 74: 157-159
        • Upadhyay G.A.
        • Vijayaraman P.
        • Nayak H.M.
        • et al.
        On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: a secondary analysis of the His-SYNC Pilot Trial.
        Heart Rhythm. 2019; 16: 1797-1807