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Bundle Branch and
Fascicular Block
Chapter 13
Robert J. Huszar, MD
Instructor
Patricia L. Thomas, MBA, RCIS
Outline
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Student Demonstration of Axis
Electrical Conduction system and Blood supply
Physiology of the Electrical Conduction System
Pathophysiology of the Bundle Branch and
Fascicular Blocks
• Right Bundle Branch Block
• QRS Complexes
• Left Bundle Branch Block
A&P of the Electrical Conduction System
• RBB runs down the right side of the IS to conduct
the electrical impulses to the RV.
• LBB short, thick, flat (main stem) conducts the
electrical impulses to IS & LV. It is divided into
two parts:
– LAF conducts electrical impulses from the main stem
to the anterior and lateral walls of LV.
– LPF conducts electrical impulses to the posterior wall
of the LV.
Blood Supply to the Electrical
Conduction System
• Anterior two thirds of the interventricular septum is
supplied by the left anterior descending CA.
• Posterior third of the septum is supplied by the posterior
descending CA.
• AV Node and Proximal Bundle of His is the AV node
artery.
• Distal Bundle of His, RBB, Main stem of LBB and Lt
Anterior Fascicle are supplied by the LAD septals.
• Left Posterior Fascicle is supplied by the LAD and PDA.
Intact viable vs. Not Intact or viable
• IVIS-is capable of conducting an electrical
impulse and depolarizing from left to right
producing and initial small q or r wave in the QRS
complex in V1,V2 & V6. Resulting synchronous
depolarization with the smaller RV buried in that
generated by the LV.
• NVIS- results because of some form of Heart
Disease, (MI) is unable to conduct an electrical
impulse and depolarize normally ( absence of a q
or r wave)