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Exercise dependent complete left bundle branch block.
H Hertzeanu1, L Aron, R J Shiner
1Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
European Heart Journal
|November 1, 1992
Summary
Exercise-dependent complete left bundle branch block (CLBBB) has a good prognosis when no underlying heart disease is found. CLBBB occurring at a heart rate below 125 bpm may not indicate coronary artery disease.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Exercise-dependent complete left bundle branch block (CLBBB) is a rare condition.
- The clinical significance and prognostic implications of CLBBB require further elucidation.
Purpose of the Study:
- To evaluate the clinical presentation, diagnostic findings, and long-term prognosis of patients with exercise-dependent CLBBB.
- To determine if exercise-dependent CLBBB, particularly at lower heart rates, is indicative of underlying coronary artery disease (CAD).
Main Methods:
- A cohort of eleven patients with exercise-dependent CLBBB was followed for 2-13 years.
- Investigations included clinical examination, ECG, exercise testing, echocardiography, radionuclide ventriculography, Holter monitoring, and coronary angiography.
- Heart rate at onset and offset of CLBBB was recorded.
Main Results:
- Four patients reported chest pain on exertion, one with palpitations.
- Coronary angiography revealed significant CAD in three patients (three-vessel disease in two, LAD obstruction in one).
- Seven patients had normal investigations, including coronary angiography; their CLBBB heart rate decreased over follow-up without proven CAD.
Conclusions:
- Exercise-dependent CLBBB has a favorable prognosis in the absence of detectable heart disease.
- Chest pain in patients with exercise-dependent CLBBB does not invariably signify CAD.
- Exercise-dependent CLBBB occurring at heart rates below 125 bpm may not be an independent marker for CAD.