Work

Treatment of painful left bundle branch block syndrome with cardiac resynchronization therapy or right-ventricular pacing

Year: 2019

Type: article

Abstract: Key Teaching Points•Painful left bundle branch block (LBBB) syndrome is a rare disorder in which a rate-related LBBB aberration causes debilitating exertional chest discomfort. The diagnosis is made clinically. The presence of tall T waves in normally conducted beats in the right precordial leads (quantified as an S wave–to–T wave ratio of ≤1.8) is supportive of this diagnosis.•The pathophysiology of this disorder is unknown. Proposed mechanisms include a disorder in the afferent neural network responsible for introception (heartbeat awareness) that may be abnormally activated during aberrant ventricular conduction in some patients, as well as disordered left ventricular activation causing dyssynchrony.•First-line treatment of painful LBBB is usually sinus node suppression using beta-blockers or ivabradine. Alternative therapies include cardiac resynchronization therapy or His-bundle pacing. However, in some cases, right ventricular pacing alone may be sufficient to control patient symptoms. •Painful left bundle branch block (LBBB) syndrome is a rare disorder in which a rate-related LBBB aberration causes debilitating exertional chest discomfort. The diagnosis is made clinically. The presence of tall T waves in normally conducted beats in the right precordial leads (quantified as an S wave–to–T wave ratio of ≤1.8) is supportive of this diagnosis.•The pathophysiology of this disorder is unknown. Proposed mechanisms include a disorder in the afferent neural network responsible for introception (heartbeat awareness) that may be abnormally activated during aberrant ventricular conduction in some patients, as well as disordered left ventricular activation causing dyssynchrony.•First-line treatment of painful LBBB is usually sinus node suppression using beta-blockers or ivabradine. Alternative therapies include cardiac resynchronization therapy or His-bundle pacing. However, in some cases, right ventricular pacing alone may be sufficient to control patient symptoms.

Source: HeartRhythm Case Reports

DOI: 10.1016/j.hrcr.2019.03.005

Authors: Jakub Sroubek, Derin Tugal, Peter J. Zimetbaum, Alexei Shvilkin, Alfred E. Buxton

Institutions: Beth Israel Deaconess Medical Center, Harvard University, South Shore Hospital

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $950