EP Europace Painfull LBBB syndrome
A 69-year-old lady presented with exertional chest discomfort. A 12-lead ECG indicated anteroseptal T wave inversion (TWI) (Panel A, left), suspicious for Wellens’ syndrome. However, cardiac catheterization (Panel A, right) and echocardiography were normal. Her symptoms persisted and she purchased a smartphone electrocardiogram (EGM) device (AliveCor KardiaMobile™, USA). Recordings revealed that her pain coincided with the sudden onset and resolution of left bundle branch block (LBBB) (Panel B, top EGM). ‘Painful LBBB Syndrome’ is an increasingly recognized entity and is easily missed following a reassuring ischaemic evaluation. These single lead recordings also illustrate associated electrophysiological phenomena. The LBBB is rate related (Panel B, top EGM), suggesting a phase 3 block. Resolution occurs at a lower rate than onset, due to ‘linking phenomenon’ whereby concealed retrograde invasion of the bundle occurs from the contralateral side. Premature ventricular contractions allowed time for the LBBB to recover (Panel B, middle), consistent with aforementioned explanations for ‘functional’ block. The TWI was also demonstrated on the KardiaMobile™ by recording an anterior precordial lead (Panel B, bottom). Known as ‘cardiac memory’, TWI transiently occurs after a period of abnormal ventricular activation.
In summary, smartphone-based EGM’s continue to improve our diagnostic capability and can illustrate complex electrophysiological phenomena
Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment- Heart Rhythm Society
No comments:
Post a Comment