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From Argentina to Denmark—The wine is still good

  • Reginald T. Ho
    Correspondence
    Address reprint requests and correspondence: Dr Reginald T. Ho, Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, 925 Chestnut St, Mezzanine Level, Philadelphia, PA 19107.
    Affiliations
    Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Published:October 21, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.10.016
      In 1968, Dr Mauricio Rosenbaum published a book dedicated entirely to the intraventricular conduction system.
      • Rosenbaum M.B.
      • Elizari M.V.
      • Lazzari J.O.
      Los Hemibloqueos.
      In this classic monograph and its subsequent English version, he coined the term “hemiblock” and introduced the concept of a trifascicular conduction system after analyzing electrocardiograms from a 58-year-old man who had suffered an anterior myocardial infarction and demonstrated right bundle branch block (RBBB) with alternating left anterior fascicular block (LAFB) and left posterior fascicular block (LPFB) (now called Rosenbaum’s syndrome).
      • Rosenbaum M.B.
      • Elizari M.V.
      • Lazzari J.O.
      The Hemiblocks: New Concepts of Intraventricular Conduction Based on Human Anatomical, Physiological and Clinical Studies.
      He referred to the conduction system as a “detector” of the heart, showing the association between various conduction blocks and heart disease (commonly coronary artery disease and Chagas cardiomyopathy in his home country of Argentina). He described the unequal “anatomic vulnerability” of the bundle branches (right more than left; left anterior more than posterior) and the relative “immunity” of the left posterior fascicle because of its thick structure and dual blood supply (indicating that the presence of LPFB generally signified more severe heart disease). His book was followed by a flurry of studies in the mid-1970s and early 1980s evaluating the value of His-ventricular intervals in predicting impending atrioventricular block (AVB) in patients with bifascicular block—research that today remain the foundation for our current pacemaker guidelines.
      • Kusumoto F.M.
      • Schoenfeld M.H.
      • Barrett C.
      • et al.
      2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: executive summary.
      Since then, however, research on the natural history of fascicular block and its progression to AVB has been relatively quiet.
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      References

        • Rosenbaum M.B.
        • Elizari M.V.
        • Lazzari J.O.
        Los Hemibloqueos.
        Editorial Paidós, Buenos Aires, Argentina1968
        • Rosenbaum M.B.
        • Elizari M.V.
        • Lazzari J.O.
        The Hemiblocks: New Concepts of Intraventricular Conduction Based on Human Anatomical, Physiological and Clinical Studies.
        Tampa Tracing, Oldsmar, FL1970
        • Kusumoto F.M.
        • Schoenfeld M.H.
        • Barrett C.
        • et al.
        2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: executive summary.
        J Am Coll Cardiol. 2019; 74: 932-987
        • Nyholm B.C.
        • Ghouse J.
        • Lee C.J.
        • et al.
        Fascicular heart blocks and risk of adverse cardiovascular outcomes: results from a large primary care population.
        Heart Rhythm. 2021; (XX:XX–XX)
        • Nielsen J.B.
        • Strandberg S.E.
        • Pietersen A.
        • et al.
        Left anterior fascicular block and the risk of cardiovascular outcomes.
        JAMA Int Med. 2014; 174: 1001-1003
        • Mandyam M.
        • Soliman E.Z.
        • Heckbert S.
        • et al.
        Long-term outcomes of left anterior fascicular block in the absence of overt cardiovascular disease.
        JAMA. 2013; 309: 1587-1588
        • Miller W.L.
        • Hodge D.O.
        • Hammill S.C.
        Association of uncomplicated electrocardiographic conduction blocks with subsequent cardiac morbidity in a community-based population (Olmsted County, Minnesota).
        Am J Cardiol. 2008; 101: 102-106
        • Calo L.
        • Della Bona R.
        • Martino A.
        • et al.
        Left posterior fascicular block and increased risk of sudden cardiac death in young people.
        J Am Coll Cardiol. 2021; 77: 1143-1145

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