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

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

“…The underlying mechanism in such cases is suggested to be the microcirculatory ischemia or coronary vasospasm . In some instances, the chest pain due to episodic LBBB has been attributed to the sudden ventricular dysynchrony rather than to myocardial ischemia but coronary vasospasm may be the underlying cause in cases with normal coronary arteriograms . Very recently, Shvilkin et al.…”

“…Very recently, Shvilkin et al. described in detail 4 patients with painful LBBB syndrome and systematically analyzed 46 additional similar patients that have been reported in the literature . Importantly, certain criteria for the diagnosis of painful LBBB syndrome were proposed .…”

“…described in detail 4 patients with painful LBBB syndrome and systematically analyzed 46 additional similar patients that have been reported in the literature . Importantly, certain criteria for the diagnosis of painful LBBB syndrome were proposed . These include: onset of chest pain the same time with LBBB development; resolution of symptoms with resolution of LBBB; normal 12‐lead LBBB (although cardiac memory T wave changes may be evident); absence of myocardial ischemia; normal left ventricular function and low precordial S/T ratio during LBBB .…”

Recurrent flash pulmonary edema due to rate-dependent left bundle branch block

“…Chest pain associated with rate-dependent LBBB in the absence of myocardial ischemia (termed the “painful LBBB syndrome”) has also been described. Although the mechanism for LBBB-induced chest pain is unknown, investigators have attributed the abnormal systolic motion of the septum as a potential trigger 4, 5. The clinical significance of rate-dependent LBBB remains unclear.…”

“…Intermittent LBBB has been noted to occur with accelerations in heart rate, typically during exercise (known as rate-dependent LBBB). This has been associated with acute deteriorations in cardiac systolic function through the development of left ventricular (LV) dyssynchrony, and also episodic chest pain (“painful LBBB syndrome”) 2, 3, 4. We present a case of an acute rate-dependent LBBB-associated cardiomyopathy with recurrent episodes of systolic heart failure and “flash” pulmonary edema that was successfully treated with cardiac resynchronization therapy (CRT).…”