Bifascicular Block

Authors: Mohd Farooq Parey, Kate Turnbull, Asim Aijaz / Editor: Frances Balmer / Codes: / Published: 26/10/2023

This learning session looks at the aetiology, diagnosis and management of bifascicular block in the Emergency Department (ED).  

Learning objectives

After completing this session, you will be able to:

  • Know the diagnostic criteria for bifascicular block
  • Understand the aetiology, pathogenesis and clinical manifestations of bifascicular block
  • Distinguish between left anterior and posterior fascicular block
  • Evaluation and management of new onset of bifascicular block
  • Risk stratification of patients with chronic bifascicular blocks in the emergency department.

References

  1. Burns E, Buttner R. Bifascicular Block. Life in the Fast Lane, 2021 [Accessed Aug 28 2023].
  2. Kusumoto FM, Schoenfeld MH, Barrett C et al. 2018 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. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-e156. doi: 10.1016/j.jacc.2018.10.044
  3. Brignole M, Moya A, de Lange FJ et al. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883
  4. Sauer WH. Chronic bifascicular blocks. UptoDate, 2022. [Accessed Aug 23 2023].
  5. Whitelaw D. Lightning Learning: Trifascicular Block. #EM3, 2017. [Accessed Aug 23 2023].
  6. Dr Smiths ECG blog: Symptomatic Bradycardia. [Internet] 2016. [Accessed Aug 23 2023].
  7. ECG Medical Training. Bifascicular Blocks What You Need To Know. [Internet] 2016. [Accessed Aug 23 2023].
  8. Shabbir MA, Saad Shaukat MH, et al. Bifascicular block in unexplained syncope is underrecognized and under-evaluated: A single-center audit of ESC guidelines adherence. PLoS One. 2022 Feb 28;17(2):e0263727.
  9. Mart-Almor J, Cladellas M, Bazn V, Delcls J, et al. [Novel predictors of progression of atrioventricular block in patients with chronic bifascicular block]. Rev Esp Cardiol. 2010 Apr;63(4):400-8. Spanish.
  10. Glikson M, Nielson J, Kronborg M et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA), European Heart Journal, Volume 42, Issue 35, 14 September 2021, Pages 34273520
  11. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation.2008;117:28202840.
  12. Miglani A, et al. Anaesthesia Tutorials. Basic Science Trifascicular Block: Diagnosis and Anaesthetic Considerations, 2022. [Accessed Aug 23 2023].

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