Painful left bundle branch block syndrome treated successfully with permanent His bundle pacing

Suryanarayana, Prakash; Frankel, David S.; Marchlinski, Francis E.; Schaller, Robert D.

doi:10.1016/j.hrcr.2018.08.005

Cited by 22 publications

(23 citation statements)

References 14 publications

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“…No defined treatment protocols are available for patients with painful LBBB syndrome, 19 but some studies have reported benefits with exercise training, cardiac resynchronization therapy by way of biventricular pacing, nonselective β-blocker therapy, and long-acting nitrates 5, 9, 10, 20, 21. More recently, Suryanarayana et al 22 reported His-bundle pacing as an effective management for painful LBBB syndrome in a patient with coexisting coronary artery disease. Likewise, Viles-Gonzalez et al 23 reported similar management in a patient with normal coronary angiography results, suggesting that this therapy remains promising.…”

Section: Discussionmentioning

confidence: 99%

Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing

Oladunjoye

Oladiran

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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A 49-year-old woman presented with exercise-induced chest discomfort during long-distance running that was occasionally present during rest. Significant coronary artery disease was excluded and a diagnosis of “painful left bundle branch block (LBBB) syndrome” was made after correlation of LBBB aberrancy with symptoms during Holter monitoring. The patient underwent confirmatory testing consisting of rapid atrial pacing below and above 130 beats per minute, the rate cut-off for LBBB manifestation. His bundle pacing implantation was performed resulting in both non-selective and selective morphologies depending on output, both of which manifested with a painless narrow QRS regardless of rate. She was rendered completely pain free during long-distance running and remains so 6-months later. Her pain at rest, now thought to be due to severe anxiety secondary to her painful LBBB, has also subsided. Exercise-induced, painful LBBB is a rare phenomenon that manifests as chest discomfort when LBBB is present. This disease is frequently misdiagnosed as coronary angina, has limited medical treatment options, and can be disabling. HBP is an attractive treatment for this syndrome in an effort to avoid electromechanical dyssynchrony, the presumed mechanism of discomfort. This case report adds to the growing literature of painful LBBB syndrome and its effective treatment with HBP, with the added caveat that it can present with persistent symptoms at rest, in the setting of enhanced anxiety. HBP should be considered early on in the treatment of such patients.

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Section: Discussionmentioning

confidence: 99%

Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing

Oladunjoye

Oladiran

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

Self Cite

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“…4 More novel technologies such as His-bundle pacing, which is a more physiologic and "natural" way to activate the conduction system, have been used with success in painful LBBB syndrome. 5 Of note, the lack of a myocardial-evoked response to His-bundle capture can result in inaccurate and misleading capture management threshold measurements. Some have reported the unexpected loss of capture during atrial capture management in conjunction with certain biventricular pacemakers when the His-bundle lead is in the LV port and the RV channel is programmed to subthreshold outputs.…”

Section: Discussionmentioning

confidence: 99%

Chest Pain Resolution with His-bundle Pacing in a Patient with Left Bundle Branch Block–related Nonischemic Left Ventricular Dysfunction

Ferrara¹,

Cappucci²,

Wang³

2019

J Innov Cardiac Rhythm Manage

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Chest pain in patients with left bundle branch block (LBBB) and normal coronaries has been reported previously in the literature. Prior cases of intermittent LBBB and "chest pain syndrome" are known of, but the causes of and treatment options for such remain unclear. A mechanism of myocardial dyssynchrony has been proposed as a possible cause of the pain, but this has not yet widely been investigated. The application of His-bundle pacing techniques to promote normal activation of the conduction system may be a treatment option. The function of cardiac implantable electronic devices can be followed via remote monitoring (RM), a vital tool in this unique patient population. The present report introduces the case of a 51-year-old female to highlight this under-recognized syndrome, including the pacing technologies used for treatment and the crucial role of RM follow-up in such affected individuals. KEYWORDS.Chest pain syndrome, His-bundle pacing, left bundle branch block, remote monitoring.

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“…In contrast, any form of RV pacing will result in highly abnormal ventricular activation and would not be expected to ameliorate symptoms related to aberrant ventricular conduction. Indeed, the patient described by Suryanarayana and colleagues 3 experienced symptoms during RV septal pacing similar to those during rate-related LBBB conduction. Yet, in the present case report, our patient had no symptoms during RV septal pacing with QRS complexes wider (160 ms) and more inferiorly directed than those seen with native LBBB (140 ms, borderline left axis deviation).…”

Section: Discussionmentioning

confidence: 89%

“…In our case series review, 4 we proposed that device-based therapies could also be useful in some instances. Indeed, 2 recent studies reported that His-bundle pacing can been used to effectively treat this syndrome2, 3; in both of these reports, His-bundle pacing at high rates yielded narrow, pseudo-fused complexes, suggesting capture of predestined left bundle branch fibers beyond the level of functional block. The fact that His-bundle pacing can control symptoms makes intuitive sense, since this strategy strives to approximate normal ventricular depolarization.…”

Section: Discussionmentioning

confidence: 99%

“…Since its earliest description in 1946 1 a variety of treatment strategies have been utilized, including pharmacologic sinus node suppression (designed to limit heart rate response to exercise, thus avoiding aberrant conduction altogether); in at least 2 instances,2, 3 His-bundle pacing has also been successfully employed to treat this disorder.…”

Section: Introductionmentioning

confidence: 99%

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

Sroubek

Tugal

Zimetbaum

et al. 2019

HeartRhythm Case Reports

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Painful left bundle branch block syndrome treated successfully with permanent His bundle pacing

Cited by 22 publications

References 14 publications

Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing

Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing

Chest Pain Resolution with His-bundle Pacing in a Patient with Left Bundle Branch Block–related Nonischemic Left Ventricular Dysfunction

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

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