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[Flecainide exercise induced left bundle branch with chest pain]
D Panagides1, M Bory, J L Bonnet
1Service de cardiologie A, CHU Timone, Marseille.
Archives Des Maladies Du Coeur Et Des Vaisseaux
|January 1, 1994
Summary
Effort-induced chest pain and left bundle branch block (LBBB) may not be caused by ischemia. Flecainide treatment for supraventricular tachycardia can induce LBBB and chest pain, resolving upon drug withdrawal.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Effort-induced chest pain alongside left bundle branch block (LBBB) has been controversially attributed to myocardial ischemia, even with normal coronary angiography.
- This study investigates an alternative mechanism for this clinical presentation.
Observation:
- Two patients presented with effort-induced chest pain and LBBB.
- Both patients were undergoing treatment for paroxysmal supraventricular tachycardia using flecainide.
Findings:
- Withdrawal of flecainide led to the resolution of both LBBB and chest pain.
- Flecainide was identified as the cause of rate-related LBBB by impairing left bundle branch conduction, independent of coronary effects.
- The chest pain was attributed to LBBB itself, not coronary ischemia.
Implications:
- This suggests that certain antiarrhythmic drugs, like flecainide, can unmask or induce LBBB and associated chest pain.
- Clinicians should consider drug-induced LBBB as a potential cause of effort-related chest pain in patients treated with flecainide.
- Coronary angiography may not be necessary in all cases presenting with effort-induced LBBB and chest pain, particularly when flecainide use is identified.