Resolution of Complete LBBB and Left Ventricular Recovery Following PCI

Left bundle branch block (LBBB) is generally considered irreversible and is associated with increased heart failure progression and mortality, particularly if associated with coronary diseases.

An 81-year-old woman with prior coronary artery bypass graft and coronary stents presented with exertional angina, LBBB (QRS 148 ms), and ejection fraction (EF) 35%. Coronary angiography revealed left anterior descending stenosis and left circumflex artery restenosis. Following percutaneous coronary intervention (PCI; left anterior descending artery [LAD] stenting, left circumflex artery percutaneous coronary angioplasty), QRS decreased to 118 ms, and EF improved to 40% by 1 month. By 6 months, LBBB resolved, QRS normalized (88 ms), and EF recovered to 60%, sustained at 12 months (QRS 84 ms, EF 60%).

While LBBB is considered irreversible, the REVIVED-BCIS2 trial questions PCI benefits in severe ischemic left ventricular dysfunction. This case contrasts, showing complete LBBB resolution and left ventricular recovery post-LAD PCI, highlighting a rare instance of reversible ischemia-related conduction disease.

To the best of our knowledge, this is the first reported experience of complete LBBB resolution with full EF recovery after LAD PCI.

Careful evaluation is needed to identify patients in whom ischemia-related conduction disease and left ventricular dysfunction may be reversible.