Previously undescribed transient trifascicular block: left septal fascicular block associated with left anterior fascicular block and complete right bundle branch block

Kjell Nikus; Jani Rankinen; Raine Virtanen; Yochai Birnbaum; Andrés Ricardo Pérez-Riera

doi:10.1016/j.jelectrocard.2025.154060

Previously undescribed transient trifascicular block: left septal fascicular block associated with left anterior fascicular block and complete right bundle branch block

Kjell Nikus^*
, Jani Rankinen
, Raine Virtanen
, Yochai Birnbaum
, Andrés Ricardo Pérez-Riera

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

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Abstract

Exercise-induced complete right bundle branch block (CRBBB) remains a rare finding during a treadmill test. Both exercise-induced CRBBB and left anterior fascicular block (LAFB) have been associated with coronary artery disease, more specifically with stenosis of the left anterior descending coronary artery. Left septal fascicular block (LSFB) has been associated with acute and chronic coronary syndromes. We describe a patient case with severe left main coronary artery disease. In an exercise test, a rare combination of these three ventricular conduction disorders developed. In a second exercise test after coronary bypass surgery, LAFB and typical CRBBB developed without LSFB.

Original language	English
Article number	154060
Journal	Journal of Electrocardiology
Volume	92
DOIs	https://doi.org/10.1016/j.jelectrocard.2025.154060
Publication status	Published - Sept 2025
Publication type	A1 Journal article-refereed

Keywords

Coronary artery disease
Left main disease
Left septal fascicular block
Prominent anterior forces
Trifascicular block

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jelectrocard.2025.154060Licence: CC BY

Previously undescribed transient trifascicular block left septal fascicular block associated with left anterior fascicular block and complete right bundle branch blockFinal published version, 2.61 MBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202508288551Licence: CC BY

Cite this

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title = "Previously undescribed transient trifascicular block: left septal fascicular block associated with left anterior fascicular block and complete right bundle branch block",

abstract = "Exercise-induced complete right bundle branch block (CRBBB) remains a rare finding during a treadmill test. Both exercise-induced CRBBB and left anterior fascicular block (LAFB) have been associated with coronary artery disease, more specifically with stenosis of the left anterior descending coronary artery. Left septal fascicular block (LSFB) has been associated with acute and chronic coronary syndromes. We describe a patient case with severe left main coronary artery disease. In an exercise test, a rare combination of these three ventricular conduction disorders developed. In a second exercise test after coronary bypass surgery, LAFB and typical CRBBB developed without LSFB.",

keywords = "Coronary artery disease, Left main disease, Left septal fascicular block, Prominent anterior forces, Trifascicular block",

author = "Kjell Nikus and Jani Rankinen and Raine Virtanen and Yochai Birnbaum and P{\'e}rez-Riera, \{Andr{\'e}s Ricardo\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = sep,

doi = "10.1016/j.jelectrocard.2025.154060",

language = "English",

volume = "92",

journal = "Journal of Electrocardiology",

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T1 - Previously undescribed transient trifascicular block

T2 - left septal fascicular block associated with left anterior fascicular block and complete right bundle branch block

AU - Nikus, Kjell

AU - Rankinen, Jani

AU - Virtanen, Raine

AU - Birnbaum, Yochai

AU - Pérez-Riera, Andrés Ricardo

PY - 2025/9

Y1 - 2025/9

N2 - Exercise-induced complete right bundle branch block (CRBBB) remains a rare finding during a treadmill test. Both exercise-induced CRBBB and left anterior fascicular block (LAFB) have been associated with coronary artery disease, more specifically with stenosis of the left anterior descending coronary artery. Left septal fascicular block (LSFB) has been associated with acute and chronic coronary syndromes. We describe a patient case with severe left main coronary artery disease. In an exercise test, a rare combination of these three ventricular conduction disorders developed. In a second exercise test after coronary bypass surgery, LAFB and typical CRBBB developed without LSFB.

AB - Exercise-induced complete right bundle branch block (CRBBB) remains a rare finding during a treadmill test. Both exercise-induced CRBBB and left anterior fascicular block (LAFB) have been associated with coronary artery disease, more specifically with stenosis of the left anterior descending coronary artery. Left septal fascicular block (LSFB) has been associated with acute and chronic coronary syndromes. We describe a patient case with severe left main coronary artery disease. In an exercise test, a rare combination of these three ventricular conduction disorders developed. In a second exercise test after coronary bypass surgery, LAFB and typical CRBBB developed without LSFB.

KW - Coronary artery disease

KW - Left main disease

KW - Left septal fascicular block

KW - Prominent anterior forces

KW - Trifascicular block

U2 - 10.1016/j.jelectrocard.2025.154060

DO - 10.1016/j.jelectrocard.2025.154060

M3 - Article

AN - SCOPUS:105010062135

SN - 0022-0736

VL - 92

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

M1 - 154060

ER -

Previously undescribed transient trifascicular block: left septal fascicular block associated with left anterior fascicular block and complete right bundle branch block

Abstract

Keywords

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