Pure anterior conduction delay: a variant "fascicular" defect.

Based upon electrocardiographic studies of conduction disturbances, the human intraventricular conduction system has been considered trifascicular: a right bundle and a bidivisional left bundle. Right bundle branch block, left anterior hemiblock, and left posterior hemiblock have been described. Microscopic and endocardial mapping studies, however, do not demonstrate a corresponding anatomical basis of this useful functional concept. Atrial premature beats in our two cases resulted in ventricular aberrancy which strongly suggests an additional form of a functional conduction delay. Such delay is manifest as a narrow QRS with anterior displacement in the horizontal plane but no axis shift in the frontal plane. This aberrancy is important to recognize because it can mimic the ECG findings of true posterior myocardial infraction. We do not postulate, however, a specific fascicle of the left bundle as the anatomic substrate for this recently recognized effect.