Bilateral Bundle Branch Block

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Abstract
Atypical bundle branch block, as defined: tracing resembling left bundle branch block in the standard leads but with evidence of complete right bundle branch block in the precordial leads and extreme left axis deviation of AQRS around[long dash]60[degree], corresponds to a bilateral bundle branch block. This is proved by analysis of 30 cases with histologic examination of the whole interventricular septum. In the great majority of the cases, bilateral bundle branch block develops into complete atrio-ventricular block (more often than not with Adams-Stokes attacks) of which it seems to be a premonitory sign. It is possible to subdivide the cases of bilateral bundle block into 2 large groups: in the 1st, which generally includes acute or old myocardial infarction, the duration of QRS is peculiarly increased, probably due to the superaddition of parietal block: the 2nd group generally concerns cases of primary degenerative changes of both branches of the bundle of His and evolves into a chronic atrio-ventricular block, with permanent brady-cardia and Adams-Stokes attacks.

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