Coronary angiographic significance of left anterior fascicular block during acute myocardial infarction

The clinical and angiographic significance of isolated left anterior fascicular block occurring during the early stage of acute myocardial infarction was studied in 141 consecutive patients who underwent cardiac catheterization before hospital discharge. Left anterior fascicular block occurred in 15 of the 62 patients with an anterior wall infarction and in 13 of the 79 with an inferior infarction. None of the clinical characteristics differed among patients with or without left anterior fascicular block. The number of coronary vessels with significant stenosis, the Friesinger and the Gensini scores for severity of stenosis and the ejection fraction were also similar in the two groups. Patients with left anterior fascicular block had more severe narrowing of the coronary artery supplying the infarct zone (88 ± 21 versus 70 ± 35%, p < 0.001) and tended to have less developed collateral circulation (collateral score 0.7 ± 0.8 versus 1 ± 0.8, p = 0.10). A significant stenosis of the left anterior descending coronary artery was found as frequently in patients with as in those without left anterior fascicular block (64 versus 65%); 29% of the patients with inferior wall infarction and left anterior fascicular block had left anterior descending coronary artery stenosis compared with 47% of the patients without this conduction disturbance (no significant difference). When the infarction was located anteriorly, a significant stenosis of the proximal segment of the left anterior descending coronary artery was present in 47% of the patients with and in 45% of the patients without left anterior fascicular block.In this study, the occurrence of left anterior fascicular block during the course of an acute myocardial infarction was not an indication of left anterior descending coronary artery involvement or of more extensive coronary disease. Other pathophysiologic mechanisms, such as a dual blood supply to the anterior fascicle of the left bundle branch or a longitudinal dissociation of conduction in the His bundle, could be involved in the etiology of left anterior fascicular block