[Cineangiographic and hemodynamic evaluation of left bundle branch block]

Left cardiac catheterisation, selective coronarography and ventriculography were employed in a study of 89 patients with left bundle-branch block. Three subjects presented normal haemodynamic and cineangiographic data, 16 displayed valve defects, usually of the aorta, 34 had ischaemic heart disease, and 36 cardiomyopathy mostly of a congestive type. Deviation of the axis in excess of--30 degrees on the frontal plane appeared to be more frequently accompanied by ischaemia, though this finding was not prognostic from the haemodynamic standpoint. A prolonged QRS (over 0.15") was more frequent in valvular heart disease and accompanied by more evident left valve dysfunction. Comparison between the 34 ischaemic patients and 317 coronary patients without left bundle-branch block showed that the former has a higher frequency of leftness in the distribution of their coronary circulation, and more extensive impairment of the coronary arteries, especially the ramus interventricularis anterior. Changes in left ventricle kinetics and serious hypokinesia and/or akinesia appear to be due to the heart disease responsible of the block. The series examined did not make it clear whether this intraventricular conduction defect can cause albeit slight alterations in left ventricle wall motility.