Painful Left Bundle Branch Block Syndrome: A Systematic Review of Treatment Strategies in Case Reports
Rodrigo Rufino Pereira Silva1, Carolina Jerônimo Magalhães1, Caio Correia da Silva1
1Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares (PROCAPE) - Universidade de Pernambuco (UPE), Recife, Brazil.
Background:
Painful left bundle branch block (PLBBB) syndrome remains a poorly understood cardiac anomaly. This systematic review consolidates case report evidence to elucidate effective management strategies and patient outcomes.
Methods:
Databases including PubMed, Scopus, Web of Science, and Scielo were searched without restrictions on language or publication date. Following PRISMA guidelines, 128 articles were identified, with 31 meeting inclusion criteria. Data were extracted on patient demographics, clinical presentation, treatment regimens, and outcomes using Microsoft Excel and assessed for bias with the Joanna Briggs Institute's tool.
Results:
The analysis included 45 patients with a mean age of 55.46 ± 12.23. Predominantly, LBBB episodes occurred during exercise (73.3%). Initial treatments comprised beta-blockers/calcium channel blockers (55.56%), pacemaker implantation (13.3%), antianginal medications (13.3%), and other modalities (17.7%). Refractoriness to initial treatment was observed in 66.7% of patients, with subsequent pacemaker implantation resolving symptoms in most cases. An overall satisfactory response was seen in 73.3% of patients post-treatment adjustments.
Conclusions:
The diverse approaches in treatment highlight the necessity for tailored therapeutic strategies. While pacemakers have demonstrated efficacy in controlling symptoms in several reported cases, it is essential to recognize the complex nature of this intervention. Pacemaker implantation, being a surgical procedure, carries long-lasting implications for patients. Hence, the continuation of pharmacological treatments might still be preferable until more definitive research is available. This review emphasizes the urgent need for further research to establish evidence-based guidelines, particularly concerning the selection of first line of treatment, to optimize outcomes for PLBBB syndrome.
