In some patients there appears to be a small continuation of the RBB distal to the moderator band toward the apical septum, which is also supplied by extensions of the moderator band and Purkinje fibers. In Tawara’s text a branch from the RBB in the moderator band gives rise to Purkinje fibers that subsequently activate the septum ( Fig. Purkinje fibers extend from the moderator band to the remainder of the RV.
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The septal band gives rise to the moderator band, which extends to the anterior papillary muscle at the apical third of the right ventricular free wall. In humans the RBB has its major route from the His bundle through the musculature of the ventricular septum.
It is possible because the anatomy of the RBB is generally uniform.
This technique may be useful in evaluating conduction over the RBB, particularly if simultaneous measurements from the LBB are also obtained from the catheter and/or if the entire pattern of right ventricular activation is determined intraoperatively. Measurement of activation times at different areas of the ventricles has been suggested as a means of indirectly assessing conduction properties of the right bundle branch (RBB) and the multiple divisions of the left bundle branch (LBB). Because it is often difficult, if not impossible, to measure conduction times and refractory periods directly from the individual fascicles via catheter, identification of specific conduction defects usually depends on recognition of an altered pattern of ventricular activation on the surface ECG.
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