A subset of individuals with the triad of first-degree heart block, right bundle branch block, and either left anterior fascicular block or left posterior fascicular block ( known as trifascicular block ) may be at an increased risk of progression to complete heart block.
12.
Adenoviral TBX18 gene transfer could create biological pacemaker activity in vivo in a large-animal model of complete heart block . Biological pacemaker activity, originating from the intramyocardial injection site, was evident in TBX18-transduced animals starting at day 2 and persisted for the duration of the study ( 14 days ) with minimal backup electronic pacemaker use.
13.
Invasive treatments include forms of catheter ablation such as "'sinus node modification "'( selective ablation of the sinus node ), "'complete sinus node ablation "'( with associated implantation of a permanent artificial pacemaker ) and "'AV node ablation "'in very resistant cases ( creation of iatrogenic complete heart block, necessitating implantation of a permanent artificial pacemaker ).
14.
Although Tawara's monograph had demonstrated that the branches of the bundle of His may transmit cardiac action potentials to the ventricles, the functional proof for his observation was not provided until 1910, when Hans Eppinger and Carl Julius Rothberger showed that cutting off both branches to induce a bilateral bundle branch block results in a complete heart block.
