Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Alexei ShvilkinMark E Josephson

Abstract

Painful left bundle branch block (LBBB) is a rarely diagnosed chest pain syndrome caused by intermittent LBBB in the absence of myocardial ischemia. Its prevalence, mechanism, detailed electrocardiographic (ECG) features, and effective treatments are not well described. The purpose of this study was to characterize clinical and ECG features of patients with painful LBBB syndrome with respect to the LBBB ECG morphology (in particular QRS axis and the precordial S/T wave ratio), clarify diagnostic criteria and possible mechanisms, and provide directions for further evaluation and treatment. We analyzed clinical (n = 50) and ECG (n = 15) features of patients with painful LBBB syndrome (4 patients in our practice and 46 cases identified in the literature). All 15 ECGs of patients with painful LBBB syndrome had an inferior QRS axis and a very low (<1.8) precordial S/T wave ratio, which was consistent with the "new LBBB" pattern. We report a case of painful LBBB syndrome coexisting with coronary artery disease. Right ventricular apical pacing resolved intractable chest pain in 1 case of painful LBBB. Painful LBBB ECG morphology within seconds/minutes of its onset is consistent with the new LBBB pattern with a very low (<1.8) precordi...Continue Reading

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Citations

Jun 15, 2016·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·George BazoukisPanagiotis Korantzopoulos
Mar 19, 2020·Circulation. Arrhythmia and Electrophysiology·Nicholas Y TanYong-Mei Cha
May 20, 2020·Arquivos brasileiros de cardiologia·José Nunes de Alencar NetoAngelo Amato Vincenzo de Paola
Jun 25, 2020·Clinical Case Reports·Kevin Andrew SmithJohn Strobel
Jan 14, 2017·Journal of the American College of Cardiology·Siva K MulpuruPaul A Friedman
Mar 23, 2021·Internal Medicine·Satoshi OkaAkinori Watanabe
Jun 14, 2019·Mayo Clinic Proceedings. Innovations, Quality & Outcomes·Olubunmi O OladunjoyeAnthony Licata
Nov 16, 2021·JAMA Internal Medicine·Ez Alddin Rajjoub Al-Mahdi, Kinan Rajjoub Al-Mahdi
Dec 12, 2020·Journal of Cardiology Cases·Christos S KonstantinouPanagiotis Korantzopoulos

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