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Left Ventricular "Longitudinal Rotation" and Conduction Abnormalities-A New Outlook on Dyssynchrony

Ibrahim Marai1,2, Rabea Haddad1,2, Nizar Andria1,2

  • 1The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Baruch Padeh Poriya Medical Center, Poriya 1528001, Israel.

Journal of Clinical Medicine
|February 11, 2023
PubMed

Insights

Complete left bundle branch block (CLBBB) causes distinct clockwise left ventricular rotation. This longitudinal rotation is significantly greater in CLBBB patients compared to those with normal conduction or right bundle branch block.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Electrophysiology

Background:

  • Complete left bundle branch block (CLBBB) leads to ventricular dyssynchrony, reducing systolic and diastolic efficiency.
  • A unique clockwise rotation of the left ventricle (LV), termed "longitudinal rotation," has been observed in CLBBB patients.

Purpose of the Study:

  • To quantify the longitudinal rotation of the LV in patients with CLBBB.
  • To compare LV longitudinal rotation in CLBBB patients versus those with normal conduction or complete right bundle branch block (CRBBB).

Main Methods:

  • Analysis of 60 patients with normal QRS, CRBBB, or CLBBB using stored DICOM 2D apical-4 chambers view cine clips.
  • Utilized EchoPac software with the SAX-MV algorithm for 2D strain analysis, excluding the posterior segment.
  • Recorded longitudinal rotation direction, peak angle, and time-to-peak rotation.

Main Results:

  • All 21 CLBBB patients exhibited clockwise longitudinal rotation (mean peak angle: -3.9 ± 2.4°).
  • This rotation was significantly larger than in normal QRS (-1.4 ± 3°, p=0.005) and CRBBB (0.1 ± 2.2°, p=0.00001) groups.
  • Clockwise rotation correlated with QRS duration in non-RBBB patterns and was not linked to reduced ejection fraction or wall abnormalities.

Conclusions:

  • Speckle-tracking echocardiography revealed significant clockwise longitudinal rotation in CLBBB patients.
  • This finding differentiates CLBBB from normal conduction and CRBBB, highlighting a specific LV mechanical alteration.
Abstract

Keywords:
CLBBBclockwiselongitudinalrotation

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