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T-wave abnormalities of intermittent left bundle-branch block.

T R Engel, R Shah, L A DePodesta

Annals of Internal Medicine

|August 1, 1978

Summary

Intermittent left bundle-branch block (LBBB) can cause T-wave abnormalities, mimicking ischemia. These changes may occur even without coronary artery disease, suggesting LBBB itself can induce them.

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Area of Science:

Cardiology
Electrophysiology

Background:

Intermittent left bundle-branch block (LBBB) is often linked to ischemia.
T-wave abnormalities, particularly right precordial inversion, are observed in some LBBB patients.

Purpose of the Study:

To investigate the clinical correlates of T-wave abnormalities in patients with intermittent LBBB.
To determine if T-wave abnormalities suggest ischemia or can be induced by LBBB itself.

Main Methods:

Analysis of 46 consecutive patients with intermittent LBBB.
Examination of T-wave abnormalities during normally conducted beats and during LBBB conduction.
Correlation with coronary heart disease status and coronary arteriograms.

Main Results:

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72% of patients showed transient right precordial T-wave inversion, suggestive of ischemia.

17 patients with T-wave inversion had no coronary heart disease; 5 had normal arteriograms.

T-wave abnormalities during LBBB conduction (48%) were more frequent than in permanent LBBB.

Nine patients exhibited T-wave abnormalities during LBBB without coronary heart disease.

Conclusions:

Right precordial T-wave inversion in intermittent LBBB may not always indicate ischemia.
Recent LBBB itself can cause T-wave abnormalities, even in the absence of coronary artery disease.
T-wave changes during LBBB conduction are also observed without significant coronary findings.