Intermittent Left Bundle Branch Block in the Athletic Heart Syndrome

Chapman, John H.

doi:10.1378/chest.71.6.776

Cited by 21 publications

(6 citation statements)

References 26 publications

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“…Episodic LBBB has been reported in several diverse clinical conditions. These are the following: coronary fistulas connecting main pulmonary artery with coronary arteries, chest trauma, cervical wound, Guillain‐Barre syndrome, takotsubo cardiomyopathy, Graves‐Basedow disease, hemorrhagic stroke, myocarditis in enteric fever, myocarditis along with acute ischemic cerebellar, pontine and lacunar infarction following viper bite, electroconvulsive therapy, endoscopic retrograde cholangiopancreatography, athletic heart syndrome, tachycardia induced cardiomyopathy, endoscopic brachytherapy for lung cancer, and propionic aciduria…”

Section: Intermittent/transient Lbbbmentioning

confidence: 99%

Episodic Left Bundle Branch Block—A Comprehensive Review of the Literature

Bazoukis

Tsimos

Korantzopoulos

2016

Noninvasive Electrocardiol

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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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Section: Intermittent/transient Lbbbmentioning

confidence: 99%

Episodic Left Bundle Branch Block—A Comprehensive Review of the Literature

Bazoukis

Tsimos

Korantzopoulos

2016

Noninvasive Electrocardiol

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“…The prognostic significance of exercise-induced LBBB has been variably reported in the literature. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Interpretation of prior studies is limited by lack of control groups, the wide spectrum of patients referred for exercise testing, crossover to coronary revascularization, and small sample sizes. Our investigation represents the largest published series to date and is the first to our knowledge to utilize a matched control cohort method.…”

Section: Commentmentioning

confidence: 99%

“…Prior studies examining the prognostic significance of exercise-induced LBBB have been limited by their small size, lack of matched controls, and failure to adjust for potential confounders. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Therefore, we performed a matched control cohort study to determine whether exercise-induced LBBB is an independent predictor for major cardiovascular morbidity and mortality in the largest series of exerciseinduced LBBB reported to date.…”

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confidence: 99%

Prognostic Significance of Exercise-Induced Left Bundle-Branch Block

Grady

Chiu

Snader

et al. 1998

JAMA

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Context.-Approximately 0.5% of all patients who undergo exercise testing develop a transient left bundle-branch block (LBBB) during exercise, but its prognostic significance is unclear.Objective.-To determine whether exercise-induced LBBB is an independent predictor of mortality and cardiac morbidity.Design.-Matched control cohort study. Between September 1990 and February 10, 1994, 17 277 exercise stress tests were performed on patients.Setting.-Tertiary care, academic medical center.Patients.-From the cohort, 70 cases of exercise-induced LBBB were identified. The controls comprised 70 individuals without LBBB at rest or during exercise that matched the 70 cases based on age, test date, sex, prior history of coronary artery disease, hypertension, diabetes, smoking, and ␤-blocker use.Main Outcome Measures.-All-cause mortality, percutaneous coronary intervention, open heart surgery, nonfatal myocardial infarction, documented symptomatic or sustained ventricular tachydysrhythmia, or implantation of a permanent pacemaker or an implantable cardiac defibrillator.Results.-A total of 37 events (28 events from the exercise-induced LBBB cases and 9 from the control cohort) occurred in 25 patients (17 exercise-induced LBBB patients and 8 control patients) during a mean follow-up period of 3.7 (0.9 years) (median, 3.8 years [range, 0.9-5.2 years]). There were 7 deaths, of which 5 occurred among patients with exercise-induced LBBB. Four-year Kaplan-Meier event rates were 19% among exercise-induced LBBB patients and 10% among controls (logrank 2 , 5.2; P=.02). After further adjusting for small differences in age, exerciseinduced LBBB remained associated with a higher risk of primary events (adjusted relative risk, 2.78; 95% confidence interval, 1.16-6.65; P=.02).Conclusion.-Exercise-induced LBBB independently predicts a higher risk of death and major cardiac events.

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“…Several cases of cardiac memory associated with LBBB in patients evaluated for chest pain have been reported [5,[12][13][14]. Whether the symptoms reported with cardiac memory were directly related to the ECG changes of cardiac memory, to the underlying depolarization abnormality leading to the cardiac memory, or were merely coincidental, remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Chest pain associated with rate-related left bundle branch block and cardiac memory mimicking ischemia

Malozzi

Wenzel

Karumbaiah

et al. 2014

Journal of Cardiology Cases

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Background: Intermittent left bundle branch block (LBBB) has been linked to chest pain, and causes cardiac memory electrocardiographic (ECG) changes mimicking ischemia. Purpose: To present a case of chest pain with ECG abnormalities suggestive of ischemia, both likely caused by LBBB. Case: A 33-year-old hypertensive female evaluated for chest pain and LBBB by ECG was treated with lisinopril and metoprolol, and scheduled for stress testing. A 12-lead ECG performed prior to the stress test, due to recurrence of the chest pain the preceding night, showed resolution of the LBBB with a lower heart rate, and T-wave inversions in the precordial leads suggestive of ischemia. She developed chest pains with reappearance of LBBB during stress testing, which prompted cardiac catheterization. This revealed normal coronaries and left ventricular systolic function. The ECG abnormalities were in retrospect likely due to cardiac memory. Her chest pains may have been caused by the intermittent, rate-related LBBB, as control of her heart rate and blood pressure with metoprolol and lisinopril improved her symptoms on follow-up. Conclusion: Intermittent LBBB causes chest pain and electrocardiographic abnormalities suggestive of ischemia in the absence of obstructive coronary disease. Certain clinical and electrocardiographic features may provide clues to a non-ischemic etiology.

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Intermittent Left Bundle Branch Block in the Athletic Heart Syndrome

Cited by 21 publications

References 26 publications

Episodic Left Bundle Branch Block—A Comprehensive Review of the Literature

Episodic Left Bundle Branch Block—A Comprehensive Review of the Literature

Prognostic Significance of Exercise-Induced Left Bundle-Branch Block

Chest pain associated with rate-related left bundle branch block and cardiac memory mimicking ischemia

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