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Non-ischemic Painful Intermittent Left Bundle Branch Block With Infra-Hisian Block Treated Successfully With

Rana Al-Zakhari1, Safa Aljammali1, Nicholas Sheets1

  • 1Internal Medicine, Richmond University Medical Center, New York, USA.

Cureus
|February 11, 2022
PubMed

Insights

Non-ischemic painful left bundle branch block (LBBB) causes chest pain due to ventricular dyssynchrony. Treatment with a biventricular pacemaker successfully resolved symptoms in a patient with intermittent LBBB.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Clinical Case Reports

Background:

  • Non-ischemic painful left bundle branch block (LBBB) is a rare condition characterized by chest pain coinciding with LBBB appearance and resolution.
  • The exact mechanism remains unclear, though ventricular dyssynchrony is a proposed cause.

Observation:

  • A 65-year-old male presented with non-ischemic chest pain and intermittent left bundle branch block (ILBBB) with infra-Hisian conduction delay.
  • Coronary artery disease was ruled out via angiography.
  • An electrophysiology study was performed to investigate the cause of chest pain and guide management.

Findings:

  • The patient's ILBBB and associated chest pain were successfully managed with a biventricular pacemaker.
  • Electrophysiology studies are crucial for diagnosing painful LBBB in the absence of coronary artery disease.

Implications:

  • This case underscores the diagnostic value of electrophysiology studies in unexplained painful LBBB.
  • Biventricular pacing may be an effective treatment for symptomatic LBBB related to ventricular dyssynchrony.
  • Further research into the pathophysiology of non-ischemic painful LBBB is warranted.

Keywords:
angiographic coronary artery diseasebiventricular pacemakerelectrophysiologyinfra-hisian blockintermittent left bundle branch blockventricular desynchrony

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