Pseudo bundle branch block produced by premature impulses arising in the bundle branches.

Pseudo bundle branch block, a previously unreported arrhythmia produced by concealed premature impulses arising in the bundle branches, was seen in two patients with sick sinus node syndrome. Although concealed conduction was not apparent in either the surface or intracardiac leads, the latter were essential in localizing the site of manifest impulse formation. Patient 1, with left bundle branch extrasystoles, had pseudo bundle branch block and pseudo atrioventricular block that depended on the timing and extent of concealment of premature depolarization. Because of the coexisting sinus bradycardia in this patient, electrical stimulation and the recording of the right ventricular apical electrograms gave additional information that helped corroborate the postulated mechanisms. Patient 2 had right bundle branch extrasystoles with sinus beats that showed a right bundle branch block pattern possibly caused by pseudo bundle branch block. In this case the possibility that both the automaticity and the conduction disturbance had a mechanical origin could not be excluded.