Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity

Sanna, Giuseppe D; Merlo, Marco; Moccia, Eleonora; Fabris, Enrico; Masia, Sara; Finocchiaro, Gherardo; Parodi, Guido; Sinagra, Gianfranco

doi:10.1016/j.ijcard.2019.06.008

Cited by 29 publications

(26 citation statements)

References 48 publications

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“…Although LBBB-induced cardiomyopathy could be also sought, our patient had no LBBB noted at rest nor did present the diagnostic criteria recently proposed by Sanna et al. 6 CRT is known to promote left ventricular reverse remodelling. In the Resynchronization Reverses Remodelling in Systolic Left Ventricular Dysfunction trial, which evaluated left ventricular remodelling after CRT, the average absolute improvement in ejection fraction was 3.6% in a follow-up of 1 year.…”

Section: Discussionmentioning

confidence: 91%

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Expanding benefits from cardiac resynchronization therapy to exercise‐induced left bundle branch block in advanced heart failure

et al. 2020

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Indications of cardiac resynchronization therapy (CRT) do not include exercise‐induced left bundle branch block, but functional impairment could be improved with CRT in such cases. A 57‐year‐old woman with idiopathic dilated cardiomyopathy (ejection fraction 23%) presented with New York Heart Association Class IV and recurrent hospitalizations. During heart transplant evaluation, a new onset of intermittent left bundle branch block was observed on the cardiopulmonary exercise test. CRT was implanted, and 97% resynchronization rate was achieved. In 12 month follow‐up, both clinical and prognostic exercise parameters improved. In patients with heart failure with reduced ejection fraction and no left bundle branch block at rest, exercise test can uncover electromechanical dyssynchrony that may benefit from CRT.

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Section: Discussionmentioning

confidence: 91%

“…We speculate that the presence of exercise‐induced LBBB was consequential to her underlying dilated cardiomyopathy and contributed to heart failure progression. Although LBBB‐induced cardiomyopathy could be also sought, our patient had no LBBB noted at rest nor did present the diagnostic criteria recently proposed by Sanna et al …”

Section: Discussionmentioning

confidence: 97%

Expanding benefits from cardiac resynchronization therapy to exercise‐induced left bundle branch block in advanced heart failure

et al. 2020

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“…In clinical practice, it is often challenging to identify the time course of development of LBBB in the setting of cardiomyopathy. The relationship between LBBB and the development of nonischemic left ventricular dysfunction is complex and a topic of ongoing research and characterization 3 …”

Section: Introductionmentioning

confidence: 99%

“…The relationship between LBBB and the development of nonischemic left ventricular dysfunction is complex and a topic of ongoing research and characterization. 3 Prior studies have shown an increased risk of overt cardiovascular disease and mortality with LBBB, with a relative risk ratio of 3.78 between isolated LBBB and development of LVSD. 4,5 In addition, multiple studies have illustrated the impaired response of patients with LBBB and both ischemic and nonischemic cardiomyopathies to guideline-directed medical therapy (GDMT).…”

Section: Introductionmentioning

confidence: 99%

His‐bundle pacing: A novel treatment for left bundle branch block‐mediated cardiomyopathy

Singh

Devabhaktuni²,

Ezzeddine

et al. 2020

Cardiovasc electrophysiol

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Background: Chronic left bundle branch block (LBBB) can lead to LBBB-mediated cardiomyopathy from left ventricular dysynchrony. His-bundle pacing (HBP) results in direct electrical synchrony using the native His-Purkinje system, providing a novel treatment for this cardiomyopathy. Objective: To assess the feasibility of HBP for cardiac resynchronization therapy (CRT) in LBBB-mediated cardiomyopathy patients. Methods: Retrospective database review was conducted on patients who underwent CRT by the HBP capable provider at Indiana University Health and Eskenazi Hospital from August 2015 to August 2017. A subset of patients who met the predefined syndrome criteria of LBBB-mediated cardiomyopathy who underwent HBP were identified. Clinical, echocardiographic, and electrocardiographic variables were extracted at baseline and follow-up. Results: Nine patients had cardiomyopathy and LBBB. Among those two were lost to follow-up. Seven patients were included in the analysis. The average time from device implantation to the last follow-up was 14.5 months. Left ventricular ejection fraction improved on average from 25% to 50% (p = .0001). The left ventricular endsystolic dimension decreased from 47 to 37 mm (p = .003) and the left ventricular end-diastolic dimension decreased from 55 to 48 mm (p = .03). QRS duration with HBP-CRT decreased from 152 to 115 ms. New York Heart Association classification improved from an average of 2.7-2. Conclusion: HBP is a viable technique for pursuing CRT in patients with LBBBmediated cardiomyopathy.

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“…It is reasonable to hypothesize that the variables whose impact proves to be diluted in large cohorts might play a pivotal role in individual patients. These variables include: (1) technical issues (e.g., correct Doppler alignment, uncertainty in the assignment of the maximum velocity of the regurgitant signal especially in presence of weak TR signals) [6,7] [8,9]. The aforementioned factors not only influence TR flow but also velocities and pressures/gradients (Fig.…”

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confidence: 99%

Accuracy of echocardiography in pulmonary hypertension: thinking outside of the box beyond the Achilles’ heel of right atrial pressure estimation

Sanna

Parodi

2021

Int J Cardiovasc Imaging

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Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity

Cited by 29 publications

References 48 publications

Expanding benefits from cardiac resynchronization therapy to exercise‐induced left bundle branch block in advanced heart failure

Expanding benefits from cardiac resynchronization therapy to exercise‐induced left bundle branch block in advanced heart failure

His‐bundle pacing: A novel treatment for left bundle branch block‐mediated cardiomyopathy

Accuracy of echocardiography in pulmonary hypertension: thinking outside of the box beyond the Achilles’ heel of right atrial pressure estimation

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