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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
PubMed
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.

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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.

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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.