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Wang L, Lu YW, Zhao YT. Chest Pain With Exercise-Induced Left Bundle-Branch Block-Is There a Connection? JAMA Intern Med 2023; 183:1160-1161. [PMID: 37639241 DOI: 10.1001/jamainternmed.2023.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
This case report describes a patient in their early 60s with chest pain during exertion.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing 100049, China
| | - Yi-Wei Lu
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing 100049, China
| | - Yun-Tao Zhao
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing 100049, China
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2
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Amir R, Vakil RM, Stevenson WG, Tandri H. Oral theophylline for treatment of painful left bundle branch block. HeartRhythm Case Rep 2023; 9:342-346. [PMID: 37361985 PMCID: PMC10285126 DOI: 10.1016/j.hrcr.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Rawan Amir
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachit M. Vakil
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William G. Stevenson
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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3
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Al-Shammari A, Edwards T, Al-Sharbatee G. Painful left bundle branch block syndrome successfully treated by His-bundle pacing. BMJ Case Rep 2022; 15:15/12/e251071. [PMID: 36535738 PMCID: PMC9764644 DOI: 10.1136/bcr-2022-251071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Painful left bundle branch block (LBBB) syndrome is a rare cause of episodic chest pain associated with transient LBBB in the absence of flow-limiting coronary artery disease and myocardial ischaemia on functional testing. The aetiology of this phenomenon is not clear, but in many reported cases, these transient episodes of LBBB are rate related. The mechanism of chest pain is not well understood. Still, it is postulated that sudden loss of the ventricular contraction synchrony, which happens in LBBB, will induce a different perception of heartbeat in the brain with possible translation to the chest pain. Various treatment modalities were attempted in the past, including exercise training, medical therapy with beta-blockers and calcium channel blockers or device therapy with right ventricle pacing, biventricular pacing and lately, His-bundle pacing. This case report presents a woman with intermittent episodes of typical angina with periodic LBBB changes on her ECG. Telemetry monitoring and treadmill exercise tests show a 100% association between angina episodes and LBBB changes on ECG. Her transthoracic echocardiogram shows normal left ventricle structure and function, and her coronary angiogram shows no flow-limiting coronary artery disease. She has been successfully treated by His-bundle pacing, and her symptoms entirely resolved on her serial follow-up.
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Affiliation(s)
| | - Tim Edwards
- Cardiology, Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK
| | - Ghadah Al-Sharbatee
- Cardiology, Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK,Renal, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
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4
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Cerantola M, Frankel DS, Callans DJ, Santangeli P, Schaller RD. Left bundle branch area pacing for the treatment of painful left bundle branch block syndrome. HeartRhythm Case Rep 2022; 9:121-125. [PMID: 36860742 PMCID: PMC9968912 DOI: 10.1016/j.hrcr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | - Robert D. Schaller
- Address reprint requests and correspondence: Dr Robert D. Schaller, Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania – Pavilion, One Convention Ave, Level 2 – City Side, Philadelphia, PA 19104.
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5
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Vijay S, Deepti S, Singh S. Painful LBBB syndrome: a rare cause of angina. BMJ Case Rep 2022; 15:e246836. [PMID: 35140085 PMCID: PMC8830201 DOI: 10.1136/bcr-2021-246836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
Painful left bundle branch block (LBBB) syndrome is an uncommon condition that is largely underdiagnosed. In this report, we describe a man in his 40s who had typical rate-dependent LBBB associated with angina without evidence of obstructive coronary artery disease.
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Affiliation(s)
- Soorampally Vijay
- Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Siddharthan Deepti
- Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sandeep Singh
- Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
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6
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Oka S, Ito S, Kai T, Hoshino K, Watanabe K, Nakamura J, Abe M, Watanabe A. Painful Left Bundle Branch Block Syndrome Complicated by Iron-Overload Cardiomyopathy. Intern Med 2021. [PMID: 33746171 DOI: 10.2169/internalmedicine.7052-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Painful left bundle branch block (LBBB) syndrome is a rare disease that presents as simultaneous chest pain and transient LBBB without myocardial ischemia. We diagnosed a 72-year-old Japanese man with painful LBBB syndrome complicated by iron-overload cardiomyopathy. Phlebotomy was initially performed to improve myocardial iron deposition and conductive disturbance. Ironically, his chest pain was fully improved by the completion of incessant LBBB and walk-through phenomenon. However, this case demonstrates a clinically significant therapeutic strategy for cardiomyopathy-induced painful LBBB syndrome. Due to the lack of treatment guidelines, individualized treatment is required for each case of painful LBBB.
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Affiliation(s)
- Satoshi Oka
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Shu Ito
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Takahiko Kai
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Katsuomi Hoshino
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | | | - Jun Nakamura
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Makoto Abe
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
| | - Akinori Watanabe
- Department of Cardiology, Fujieda Municipal General Hospital, Japan
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7
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Konstantinou CS, Kalantzi K, Tsimos K, Pappa E, Korantzopoulos P. Painful left bundle branch block: A syndrome with a particular clinical significance. J Cardiol Cases 2020; 22:273-275. [DOI: 10.1016/j.jccase.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
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8
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Ferrara MG, Cappucci RV, Wang DY. Chest Pain Resolution with His-bundle Pacing in a Patient with Left Bundle Branch Block-related Nonischemic Left Ventricular Dysfunction. J Innov Card Rhythm Manag 2020; 10:3810-3814. [PMID: 32494425 PMCID: PMC7252840 DOI: 10.19102/icrm.2019.100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/05/2019] [Indexed: 11/06/2022] Open
Abstract
Chest pain in patients with left bundle branch block (LBBB) and normal coronaries has been reported previously in the literature. Prior cases of intermittent LBBB and "chest pain syndrome" are known of, but the causes of and treatment options for such remain unclear. A mechanism of myocardial dyssynchrony has been proposed as a possible cause of the pain, but this has not yet widely been investigated. The application of His-bundle pacing techniques to promote normal activation of the conduction system may be a treatment option. The function of cardiac implantable electronic devices can be followed via remote monitoring (RM), a vital tool in this unique patient population. The present report introduces the case of a 51-year-old female to highlight this under-recognized syndrome, including the pacing technologies used for treatment and the crucial role of RM follow-up in such affected individuals.
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Affiliation(s)
- Martha G Ferrara
- White Plains Hospital Center, Montefiore Health System, White Plains, NY, USA
| | - Roger V Cappucci
- White Plains Hospital Center, Montefiore Health System, White Plains, NY, USA
| | - Daniel Y Wang
- White Plains Hospital Center, Montefiore Health System, White Plains, NY, USA
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9
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Smith KA, Frey J, McKenzie A, Hornsby K, Strobel J. The use of His bundle pacing for the treatment of painful left bundle branch block syndrome. Clin Case Rep 2020; 8:1025-1029. [PMID: 32577257 PMCID: PMC7303847 DOI: 10.1002/ccr3.2793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 11/08/2022] Open
Abstract
Painful left bundle branch block syndrome is a rare disorder in which patients develop typical angina-like pain without identifiable ischemia. To date, there have been few published cases of effective treatment. In this case report, we describe successful implementation of His bundle pacing for durable symptom resolution in this disorder.
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Affiliation(s)
| | - Julie Frey
- Indiana University HealthSouthern Indiana PhysiciansBloomingtonIndiana
| | - Amber McKenzie
- Cardiopulmonary Rehab/Diabetes Center/Advanced Heart Care Center Indiana University Health BloomingtonBloomingtonIndiana
| | - Kyle Hornsby
- Indiana University School of MedicineIndianapolisIndiana
- Indiana University HealthSouthern Indiana PhysiciansBloomingtonIndiana
| | - John Strobel
- Indiana University School of MedicineIndianapolisIndiana
- Indiana University HealthSouthern Indiana PhysiciansBloomingtonIndiana
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10
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Alencar Neto JND, Sakai MH, Moraes SRRD, Frota ESD, Cirenza C, Paola AAVD. Painful Left Bundle Branch Block Syndrome in a Patient Referred to Electrophysiologic Study: A Case Report. Arq Bras Cardiol 2020; 114:34-37. [PMID: 32428098 PMCID: PMC8149111 DOI: 10.36660/abc.20190295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/18/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Marcel Henrique Sakai
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Elano Sousa da Frota
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Claudio Cirenza
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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11
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Garg A, Master V, Ellenbogen KA, Padala SK. Painful Left Bundle Branch Block Syndrome Successfully Treated With Left Bundle Branch Area Pacing. JACC Case Rep 2020; 2:568-571. [PMID: 34317295 PMCID: PMC8298553 DOI: 10.1016/j.jaccas.2019.11.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/08/2019] [Accepted: 11/27/2019] [Indexed: 10/27/2022]
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12
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Abstract
Left bundle branch block may be due to conduction system degeneration or a reflection of myocardial pathology. Left bundle branch block may also develop following aortic valve disease or cardiac procedures. Patients with heart failure with reduced ejection fraction and left bundle branch block may respond positively to cardiac resynchronization therapy. Lead placement via the coronary sinus is the mainstay approach of cardiac resynchronization therapy. However, other options, including physiological pacing, are being explored. In this review, we summarize the salient pathophysiologic and clinical aspects of left bundle branch block, as well as current and future strategies for management.
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Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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13
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Oechslin L, Hofer D, Hermann M. [CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome]. PRAXIS 2020; 109:1017-1025. [PMID: 33050815 DOI: 10.1024/1661-8157/a003543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.
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Affiliation(s)
| | - Daniel Hofer
- Klinik für Kardiologie, Universitätsspital Zürich
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14
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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15
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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16
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Oladunjoye OO, Oladunjoye AO, Oladiran O, Callans DJ, Schaller RD, Licata A. Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing. Mayo Clin Proc Innov Qual Outcomes 2019; 3:226-230. [PMID: 31193904 PMCID: PMC6543455 DOI: 10.1016/j.mayocpiqo.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 49-year-old woman presented with exercise-induced chest discomfort during long-distance running that was occasionally present during rest. Significant coronary artery disease was excluded and a diagnosis of “painful left bundle branch block (LBBB) syndrome” was made after correlation of LBBB aberrancy with symptoms during Holter monitoring. The patient underwent confirmatory testing consisting of rapid atrial pacing below and above 130 beats per minute, the rate cut-off for LBBB manifestation. His bundle pacing implantation was performed resulting in both non-selective and selective morphologies depending on output, both of which manifested with a painless narrow QRS regardless of rate. She was rendered completely pain free during long-distance running and remains so 6-months later. Her pain at rest, now thought to be due to severe anxiety secondary to her painful LBBB, has also subsided. Exercise-induced, painful LBBB is a rare phenomenon that manifests as chest discomfort when LBBB is present. This disease is frequently misdiagnosed as coronary angina, has limited medical treatment options, and can be disabling. HBP is an attractive treatment for this syndrome in an effort to avoid electromechanical dyssynchrony, the presumed mechanism of discomfort. This case report adds to the growing literature of painful LBBB syndrome and its effective treatment with HBP, with the added caveat that it can present with persistent symptoms at rest, in the setting of enhanced anxiety. HBP should be considered early on in the treatment of such patients.
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Affiliation(s)
| | | | | | - David J Callans
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Anthony Licata
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, Reading, PA
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Tyagi A, Sethi AK, Agarwal V, Mohta M. Rate-dependent Left Bundle Branch Block during Anaesthesia. Anaesth Intensive Care 2019; 32:715-8. [PMID: 15535502 DOI: 10.1177/0310057x0403200521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rate-dependent left bundle branch block during general anaesthesia is rare. Its occurrence makes electrocardiographic diagnosis of acute myocardial ischaemia or infarction difficult. It can also be confused with a slow rate ventricular tachycardia. We present a case of rate-dependent left bundle branch block in a patient with no previous history of ischaemic heart disease. Carotid sinus massage resulted in a decrease in heart rate and reversion to normal sinus rhythm.
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Affiliation(s)
- A Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Shahadra, Delhi, India
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19
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Gomez M, Lorente Castro B, Jané P, García-Zoghby L, Martínez-Lorca A, Pérez J. Exercise induced left bundle branch block in isotopic exercise test. Findings and prognostic value. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Painful left bundle branch block syndrome treated with his bundle pacing. J Electrocardiol 2018; 51:1019-1022. [PMID: 30497723 DOI: 10.1016/j.jelectrocard.2018.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/07/2018] [Accepted: 08/12/2018] [Indexed: 12/22/2022]
Abstract
This is a case report of a patient with painful LBBB Syndrome that responded favorably to His Bundle Pacing. This syndrome is largely under recognized despite 50 reports in the literature over the last 60 years. Both diagnosis and treatment are not well defined and represent a major challenge in patients with this entity. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. We report for the first-time complete resolution of chest pain with His bundle pacing. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with a painful LBBB syndrome.
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21
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Suryanarayana PG, Frankel DS, Marchlinski FE, Schaller RD. Painful left bundle branch block [corrected] syndrome treated successfully with permanent His bundle pacing. HeartRhythm Case Rep 2018; 4:439-443. [PMID: 30364759 PMCID: PMC6197638 DOI: 10.1016/j.hrcr.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | - Robert D. Schaller
- Address reprint requests and correspondence: Dr Robert D. Schaller, Hospital of the University of Pennsylvania, 9 Founders Pavilion – Cardiology, 3400 Spruce St, Philadelphia, PA 19104.
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22
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Seibolt L, Maestas C, Lazkani M, Fatima U, Loli A, Chesser M. Rate-related left bundle branch block and cardiac memory in a patient with bradycardia: Case report and literature review. Clin Cardiol 2018; 41:1097-1102. [PMID: 29920728 DOI: 10.1002/clc.22997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 11/08/2022] Open
Abstract
Rate-related left bundle branch block (LBBB) is a well-studied phenomenon. Cardiac memory is another physiologic phenomenon in which T-wave abnormalities occur in the absence of ischemia. The association between these 2 phenomena has been described in several case reports. A literature review was performed through Ovid and PubMed, where at total of 93 cases of rate-related LBBB were identified. Cases were reviewed, and data were collected on rates of appearance and disappearance as well as the presence or absence of cardiac memory. There is some overlap in the rate at which LBBB appears. Cardiac memory is associated with rate-related LBBB in several cases, but its true prevalence is unknown. Cardiac memory is a phenomenon that is well described in the literature but is often underrecognized in clinical practice. As a consequence of overlooking this phenomenon and not including cardiac memory in the differential when T-wave abnormalities are observed, patients may be subjected to unnecessary invasive diagnostic testing.
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Affiliation(s)
- Luke Seibolt
- Department of Cardiology, Banner University, Medical Center, Phoenix, Arizona
| | - Camila Maestas
- Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona
| | - Mohamad Lazkani
- Department of Cardiology, Banner University, Medical Center, Phoenix, Arizona
| | - Umaima Fatima
- Department of Cardiology, Phoenix Veterans Affairs Medical Center, Phoenix, Arizona
| | - Akil Loli
- Department of Cardiology, Banner University, Medical Center, Phoenix, Arizona
| | - Michael Chesser
- Department of Internal Medicine, Phoenix Veterans Affairs Medical Center, Phoenix, Arizona
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23
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Gomez MV, Lorente Castro BC, Jané P, García-Zoghby L, Martínez-Lorca A, Pérez JA. Exercise induced left bundle branch block in isotopic exercise test. Findings and prognostic value. Rev Esp Med Nucl Imagen Mol 2018; 37:273-276. [PMID: 29680771 DOI: 10.1016/j.remn.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/16/2018] [Accepted: 02/21/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Exercise-induced left bundle branch block (EI-LBBB) is a rare circumstance of unknown significance. The purpose of this paper is to describe the scintigraphic features and the prognostic value of this finding. MATERIAL AND METHODS We reviewed the features of 1,885 patients who had visited our department to undergo GATED-SPECT ergometry to diagnose ischaemic heart disease. Seven patients showed EI-LBBB throughout the exercise testing. Coronary angiography was performed in 4 of them. Patients were followed-up over an average period of time of 30±8 months. The onset of major cardiovascular events was recorded during the follow-up period. RESULTS The prevalence of EI-LBBB was 0.37%. Six out of 7 patients were women. Myocardial function and perfusion were normal in 3 patients. Three patients had fixed perfusion defects and one patient had a reversible defect. Two out of the 4 patients showing perfusion defects presented a moderate-severe decrease of the left ventricular ejection fraction. None of the 4 patients with perfusion defects were found to have coronary disease on coronary angiography. CONCLUSIONS The prevalence of EI-LBBB among the patients that came to undergo GATED-SPECT ergometry was very low. The finding was more frequent in women. In our series, 2 patients presented non-ischaemic structural heart disease, but no patient was diagnosed with coronary artery disease. In our patients the presence of EI-LBBB did not relate to a greater risk of experiencing a major cardiovascular event.
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Affiliation(s)
- M V Gomez
- Medicina Nuclear, Hospital Ramón y Cajal, Madrid, España.
| | | | - P Jané
- Hospital Universitario Ramón y Cajal, Madrid, España
| | | | | | - J A Pérez
- Hospital Universitario Ramón y Cajal, Madrid, España
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Bazoukis G, Tsimos K, Korantzopoulos P. Episodic Left Bundle Branch Block-A Comprehensive Review of the Literature. Ann Noninvasive Electrocardiol 2016; 21:117-25. [PMID: 27296905 DOI: 10.1111/anec.12361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/10/2016] [Accepted: 01/19/2016] [Indexed: 01/09/2023] Open
Abstract
Episodic (transient/ intermittent) left bundle branch block (LBBB) has been associated with different conditions such as bradycardia, tachycardia, anesthesia, acute pulmonary embolism, changes in intrathoracic pressure, chest trauma, cardiac interventional procedures, mad honey poisoning, and in other clinical settings. Of note, exclusion of an acute coronary syndrome in the setting of episodic LBBB is of great importance. Moreover, episodic LBBB is sometimes symptomatic and may be associated with left ventricular systolic and/or diastolic dysfunction or conduction disturbances leading to syncope. This review article provides a comprehensive overview of the conditions associated with episodic LBBB and discusses the clinical impact of this phenomenon.
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Affiliation(s)
- George Bazoukis
- Department of Internal Medicine, General Hospital of Athens "Elpis,", Athens, Greece
| | - Konstantinos Tsimos
- First Department of Cardiology, University of Ioannina, Medical School, Ioannina, Greece
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Shvilkin A, Ellis ER, Gervino EV, Litvak AD, Buxton AE, Josephson ME. Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment. Heart Rhythm 2016; 13:226-32. [DOI: 10.1016/j.hrthm.2015.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 11/15/2022]
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Malozzi C, Wenzel G, Karumbaiah K, Courtney M, Omar B. Chest pain associated with rate-related left bundle branch block and cardiac memory mimicking ischemia. J Cardiol Cases 2014; 9:87-90. [DOI: 10.1016/j.jccase.2013.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/10/2013] [Accepted: 10/09/2013] [Indexed: 11/15/2022] Open
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Exercise induced left bundle branch block treated with cardiac rehabilitation: a case report and a review of the literature. Case Rep Vasc Med 2014; 2014:204805. [PMID: 24716091 PMCID: PMC3971859 DOI: 10.1155/2014/204805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/23/2013] [Indexed: 01/09/2023] Open
Abstract
Exercise induced bundle branch block is a rare observation in exercise testing, accounting for 0.5 percent of exercise tests. The best treatment of this condition and its association with coronary disease remain unclear. We describe a case associated with normal coronary arteries which was successfully treated with exercise training. While this treatment has been used previously, our case has a longer followup than previously reported and demonstrates that the treatment is not durable in the absence of continued exercise.
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28
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Said SAM, Bultje-Peters M, Nijhuis RLG. Exercise-induced left bundle branch block: an infrequent phenomenon: Report of two cases. World J Cardiol 2013; 5:359-363. [PMID: 24109500 PMCID: PMC3783989 DOI: 10.4330/wjc.v5.i9.359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/19/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
Exercise-induced left bundle branch block (EI-LBBB) is infrequent phenomenon. We present two patients with angina pectoris who developed EI-LBBB during exercise tolerance test. The first patient with typical angina pectoris had significant obstructive coronary artery disease (CAD) requiring percutaneous coronary intervention of multiple lesions including placement of drug eluting stents. The second patient had atypical chest pain without signs of CAD at all. EI-LBBB occurred at a heart rate of 80 bpm and 141 bpm in the first and second patient, respectively. EI-LBBB remained visible through the test till the recovery period in the first patient at a heart rate of 83 bpm and disappeared at 96 bpm in the second patient. Both patients with this infrequent phenomenon are discussed and the literature is reviewed.
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29
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A misleading resting ECG in a patient with left bundle branch block. JAAPA 2011; 24:32, 34-5. [DOI: 10.1097/01720610-201101000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shvilkin A, Bojovic B, Vajdic B, Gussak I, Ho KK, Zimetbaum P, Josephson ME. Vectorcardiographic and electrocardiographic criteria to distinguish new and old left bundle branch block. Heart Rhythm 2010; 7:1085-92. [DOI: 10.1016/j.hrthm.2010.05.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
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31
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Stein R, Nguyen P, Abella J, Olson H, Myers J, Froelicher V. Prevalence and prognostic significance of exercise-induced right bundle branch block. Am J Cardiol 2010; 105:677-80. [PMID: 20185016 DOI: 10.1016/j.amjcard.2009.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 10/25/2009] [Accepted: 10/25/2009] [Indexed: 11/25/2022]
Abstract
Exercise-induced (EI) right bundle branch block (RBBB) is an infrequent electrocardiographic phenomenon, and controversy exists regarding its association with cardiovascular disease. We compared the prevalence and prognostic significance of RBBB, abnormal ST depression, and normal electrocardiographic findings in response to exercise testing in 9,623 consecutive veterans who underwent exercise testing from 1987 to 2007. EI RBBB, EI ST depression, and a normal exercise electrocardiographic response occurred in 0.24%, 15.2%, and 71.9% veterans, respectively. After appropriate exclusions, of the 8,047 patients analyzed, 6 patients in the EI RBBB subgroup died. Of these 6 deaths, 3 were cardiovascular deaths during the 9 years of follow-up. The annual death rate was 7.3% (1.4% cardiac deaths), 2.6% (1.2% cardiac deaths), and 1.8% (0.6% cardiac death) among those with EI RBBB, EI ST depression, and a normal ST response, respectively (p <0.0001). The patients with EI RBBB were significantly older, more overweight, and had a greater prevalence of coronary artery disease, heart failure, and hypertension compared to the 2 other subgroups. Patients with EI RBBB had an age-adjusted Cox proportional hazard ratio of 1.13 (p = 0.75, 95% confidence interval 0.51 to 2.5) for all-cause mortality and 1.57 (p = 0.43, 95% confidence interval 0.51 to 4.8) for cardiovascular mortality, respectively. In conclusion, EI RBBB is a rare occurrence during routine clinical exercise testing that appears to be benign.
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32
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Weiss T, Elitzur Y, Rott D, Leibowitz D. Carotid sinus massage in patients with suspected acute myocardial infarction, tachycardia, and left bundle branch block. Am J Med 2009; 122:e1-2. [PMID: 19486698 DOI: 10.1016/j.amjmed.2009.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 01/06/2009] [Accepted: 01/06/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Teddy Weiss
- Coronary Care Unit, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
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Im KS, Jung HJ, Lee JM, Park K, Kim JB, Sim JC. Rate-dependent Left Bundle Branch Block during General Anesthesia - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.3.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kyung Sil Im
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Ju Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myeong Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kuhn Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Bun Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Cheol Sim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Michaelides AP, Kartalis AN, Aigyptiadou MNK, Toutouzas PK. Exercise-induced left bundle branch block accompanied by chest pain. Correlation with coronary artery disease. J Electrocardiol 2005; 37:325-8. [PMID: 15484163 DOI: 10.1016/j.jelectrocard.2004.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of a 25-year-old woman with familiar hypercholesterolemia, who was admitted complaining for chest pain on exertion, is presented. She underwent a treadmill stress test and during the exercise left bundle branch block with concomitant chest pain in low heart rate (105/min) was demonstrated. After these findings TL-201 scintigraphy with dipyridamole infusion was performed: Chest pain and left bundle branch block appeared again during the test, and the stress TL-201 tomographic images showed reversible defect in the anterior wall. Finally, the young woman underwent coronary arteriography, which showed normal coronary vessels. The ergonovine test for coronary spasm was negative.
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Affiliation(s)
- Andreas P Michaelides
- Department of Cardiology of Medical School of Athens University, Hippokration Hospital, Athens, Greece
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35
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Ciaroni S, Urban P. Painful left bundle branch block detected during dobutamine stress echocardiography. J Am Soc Echocardiogr 2002; 15:1405-8. [PMID: 12415237 DOI: 10.1067/mje.2002.124005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report on the observation, in a 50-year-old woman undergoing dobutamine stress echocardiography, of the simultaneous onset of complete left bundle branch block and anginal chest pain, unaccompanied by any abnormality of left ventricular segmental contraction or wall thickening. Further etiologic investigations, in particular for coronary artery disease, proved negative. This observation is discussed in the context of a literature review.
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Affiliation(s)
- Stefano Ciaroni
- Service de cardiologie, Hôpital de la Tour, Meyrin-Geneva, Switzerland
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36
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Candell Riera J, Oller Martínez G, Vega J, Gordillo E, Ferreira I, Peña C, Castell J, Aguadé S, Soler Soler J. [Exercise-induced left bundle-branch block in patients with coronary artery disease versus patients with normal coronary arteries]. Rev Esp Cardiol 2002. [PMID: 12015926 DOI: 10.1016/s0300-8932(02)76638-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES Exercise-induced left bundle-branch block does not always denote the presence of underlying coronary artery disease. The aim of this study was to analyze the clinical characteristics and evolution of patients with rate-dependent left bundle-branch block. PATIENTS AND METHOD 9,318 consecutive exercise stress studies were reviewed. The clinical characteristics and evolution (mean follow-up: 6.9 years) of 20 patients with exercise-induced left bundle-branch block in which coronary angiography had been performed were analyzed. RESULTS Eight out of 20 patients had normal coronary arteries (group A) and 12 had coronary artery disease (group B). Peak O2 consumption, peak myocardial O2 consumption, and heart rate when block appeared (132 20 vs. 95.4 23 beats/min; p = 0.002) were significantly higher in group A. Seven of the 8 patients with normal coronary arteries had chest pain coinciding with the first beat of left bundle-branch block. There were no deaths during follow-up in group A, but permanent left bundle-branch block appeared in 5 patients of this group who experienced disappearance of exercise-related pain. There were 3 deaths in group B and 2 patients had acute myocardial infarction during follow-up. One patient in each group developed atrioventricular block and required pacemaker implantation. CONCLUSIONS In contrast with patients with left bundle-branch block and coronary artery disease, the prognosis of patients with painful left bundle-branch block and normal coronary arteries is good. However, the development of permanent left bundle-branch block is frequent. Atrioventricular block, although rare, may occur.
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Affiliation(s)
- Jaume Candell Riera
- Servicios de Cardiología y Medicina Nuclear. Hospital Universitari Vall d'Hebron. Barcelona. Spain.
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Candell-Riera J, Gordillo E, Oller-Martínez G, Peña C, Ferreira I, Soler-Soler J. Long-term outcome of painful left bundle branch block. Am J Cardiol 2002; 89:602-4. [PMID: 11867050 DOI: 10.1016/s0002-9149(01)02304-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Left bundle branch block (LBBB), traditionally viewed as an electrophysiologic abnormality, is increasingly recognized for its profound hemodynamic effects. LBBB causes asynchronous myocardial activation, which, in turn, may trigger ventricular remodeling. Exercise nuclear studies frequently show reversible perfusion defects in the absence of obstructive coronary artery disease and some patients with intermittent LBBB develop angina coincident with the onset of LBBB. It is uncertain, however, if these phenomena are because of myocardial ischemia or ventricular asynergy. LBBB is associated with impaired systolic and diastolic function. In patients with dilated cardiomyopathy (DCM), LBBB is accompanied by progressive left ventricular (LV) dilatation and mitral regurgitation. It is not known whether LBBB is the cause or the consequence of LV dilatation. DCM patients with LBBB, as compared to those with normal intraventricular conduction, are more likely to have a nonischemic etiology, profound LV dilatation, lower ejection fraction, increased symptomatology, and shorter survival. Patients with DCM and acceleration-dependent LBBB may benefit from restoration of a narrow QRS complex by suppressing the heart rate with beta-blocker. There is extensive research underway in patients with DCM and LBBB to evaluate the short and long-term effects of normalization of ventricular activation sequence with high septal, LV, or biventricular pacing.
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Affiliation(s)
- L Littmann
- Department of Internal Medicine and the Sanger Clinic, P.A., Carolinas Medical Center, Charlotte, NC 28232, USA.
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Moran JF, Scurlock B, Henkin R, Scanlon PJ. The clinical significance of exercise-induced bundle branch block. J Electrocardiol 1992; 25:229-35. [PMID: 1645063 DOI: 10.1016/0022-0736(92)90008-n] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise-induced bundle branch block is an uncommon electrocardiographic entity said to be associated with coronary heart disease. Thirty-seven patients were studied to determine if exercise hemodynamics and stress/rest thallium scans could identify those patients with coronary heart disease. Eighteen patients of the study group also had coronary angiography. Group I (n = 17) with normal thallium scans and group II (n = 20) with abnormal thallium scans had significantly different maximal heart rate, maximal blood pressure, and double product in exercise as well as duration of exercise. Clinical evaluation of the patient study group permitted a division of the patients into two subgroups: group A, atypical chest pain or abnormal exercise electrocardiogram (n = 12), and group B, definite or probable angina (n = 25). Group B patients had significantly more abnormal thallium scans (17/25) than group A patients (3/12) (p less than 0.04). When compared to coronary angiography, stress/rest thallium scans had a predictive accuracy of 85% for coronary heart disease. While exercise-induced ST-segment depression and R wave amplitude increases are not specific in exercise-induced bundle branch block, exercise hemodynamics and stress/rest thallium scans can help diagnose patients with coronary heart disease. These test findings added to a clinical evaluation permit a more accurate stratification of the patients and indicate which patients need further study.
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Affiliation(s)
- J F Moran
- Loyola University Medical Center, Maywood, Illinois
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40
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Perin E, Petersen F, Massumi A. Rate-related left bundle branch block as a cause of non-ischemic chest pain. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 22:45-6. [PMID: 1995174 DOI: 10.1002/ccd.1810220111] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case is presented of rate-dependent left bundle branch block associated with chest pain in a patient with angiographically normal coronary arteries. Lactate extraction showed no evidence of myocardial ischemia. It appears that in this case, chest pain was associated with sudden ventricular asynergy rather than myocardial ischemia.
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Affiliation(s)
- E Perin
- Department of Adult Cardiology, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston 77030
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Affiliation(s)
- H Koito
- Department of Medicine, University of Massachusetts Medical School, Worcester
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42
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Williams MA, Esterbrooks DJ, Nair CK, Sailors MM, Sketch MH. Clinical significance of exercise-induced bundle branch block. Am J Cardiol 1988; 61:346-8. [PMID: 3341213 DOI: 10.1016/0002-9149(88)90942-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To evaluate the diagnostic significance and long-term follow-up data of patients with exercise-induced bundle branch block (BBB), 10,176 consecutive patients' exercise test data were reviewed and 50 patients found to have exercise-induced BBB. Clinical, exercise test and arteriographic data were analyzed along with follow-up data during a mean of 43 months. Of the 50 patients, 37 had exercise-induced left BBB and 13 had exercise-induced right BBB. Significant coronary artery disease (CAD) was diagnosed in 26 of 37 patients (70%) with exercise-induced left BBB and in all 13 patients (100%) with exercise-induced right BBB. In patients who underwent coronary arteriography, data demonstrated a high prevalence of proximal left anterior descending disease (17 of 20, 85%). Follow-up data revealed that exercise-induced BBB was associated with a 36% (18 of 50) incidence of coronary events, including 16 patients who underwent coronary artery bypass grafting and 2 hospitalized for congestive heart failure. Results indicated that exercise-induced BBB was infrequent and occurred primarily in association with CAD, had a high prevalence of proximal left anterior CAD, infrequently had similar onset and offset heart rates, was reproducible and associated with a greater incidence of coronary artery bypass grafting than had been previously reported, although the incidence of cardiac events was similar to those investigations.
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Affiliation(s)
- M A Williams
- Division of Cardiology, Creighton University Medical School, Omaha, Nebraska
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Heinsimer JA, Irwin JM, Basnight LL. Influence of underlying coronary artery disease on the natural history and prognosis of exercise-induced left bundle branch block. Am J Cardiol 1987; 60:1065-7. [PMID: 3673908 DOI: 10.1016/0002-9149(87)90353-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The long-term prognosis of exercise-induced left bundle branch block (BBB) in patients with and without underlying coronary artery disease (CAD) was examined by following 15 patients (7 with normal coronary arteries and 8 with CAD) for an average of 6.6 years (range 2.2 to 11.2). Over the follow-up interval, permanent left BBB developed in 8 of the 15 patients. Seven of these 8 had underlying CAD, compared to 0 of 6 patients with normal coronary arteries and normal left ventricular function (p less than 0.002). In 1 patient with normal coronary arteries and a left ventricular ejection fraction of 0.34, permanent left BBB developed. During follow-up, 4 patients died; 3 had significant CAD and 1 had depressed left ventricular function. In no patient did high-grade atrioventricular block develop and no patient required pacing. Thus, development of permanent left BBB in patients with exercise-induced left BBB is related to presence or absence of underlying CAD or myocardial disease. When left BBB is found in the absence of underlying heart disease, there does not tend to be progression of the conduction disturbance and the prognosis is excellent.
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Affiliation(s)
- J A Heinsimer
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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44
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Heinsimer JA, Skelton TN, Califf RM. Rate-related left bundle branch block with chest pain and normal coronary arteriograms treated by exercise training. Am J Med Sci 1986; 292:317-9. [PMID: 3777016 DOI: 10.1097/00000441-198611000-00013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A clinical observation of chest pain associated with the onset of rate-related left bundle branch block has been described in patients with normal coronary arteriograms. The authors used standard cardiac rehabilitation techniques for exercise training in a 47-year-old woman with these manifestations. Serial treadmill tests revealed that during the course of 3 months of exercise training, the heart rate at onset of LBBB gradually rose from 133 to 175 beats per minute, and she no longer developed symptoms during her routine daily activities or exercises. Exercise training was a successful nonpharmacologic strategy that delayed the onset of rate-related LBBB and chest pain in this patient and avoided the need for beta blocker therapy.
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45
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Vasey C, O'Donnell J, Morris S, McHenry P. Exercise-induced left bundle branch block and its relation to coronary artery disease. Am J Cardiol 1985; 56:892-5. [PMID: 4061330 DOI: 10.1016/0002-9149(85)90777-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The records of 2,584 consecutive patients who underwent both treadmill exercise testing and coronary cineangiography were reviewed to determine the relation between exercise-induced, acceleration-dependent left bundle branch block (LBBB) and the presence of coronary artery disease (CAD). Rate-dependent LBBB during exercise was identified in 28 patients (1.1%), who were categorized according to their presenting symptoms: classic angina pectoris, atypical chest pain, symptomatic cardiac arrhythmia and asymptomatic. Asymptomatic patients underwent a screening exercise test. CAD was present in 7 of 10 patients who presented with classic angina pectoris, but 12 of 13 patients presenting with atypical chest pain had normal coronary arteries. All 10 patients in whom LBBB developed at a heart rate of 125 beats/min or higher were free of CAD, whereas 9 of 18 patients in whom LBBB developed at a heart rate of less than 125 beats/min had CAD. Normal coronary arteries were present in 3 patients who presented with angina and in whom both chest pain and LBBB developed during exercise. It is concluded that patients who present with atypical chest pain in whom rate-dependent LBBB develops on the treadmill are significantly less likely to have CAD than patients who present with classic angina; the onset of LBBB at a heart rate of 125 beats/min or higher is highly correlated with the presence of normal coronary arteries, regardless of patient presentation; and patients with angina in whom both chest pain and LBBB develop during exercise may have normal coronary arteries.
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46
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Kafka H, Burggraf GW. Exercise-induced left bundle branch block and chest discomfort without myocardial ischemia. Am J Cardiol 1984; 54:676-7. [PMID: 6475797 DOI: 10.1016/0002-9149(84)90276-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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