Left bundle branch block | |
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ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. | |
Specialty | Cardiology, Emergency Medicine |
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Left bundle branch block (LBBB) is a cardiac conduction abnormality seen on the electrocardiogram (ECG).[1] In this condition, activation of the left ventricle of the heart is delayed, which causes the left ventricle to contract later than the right ventricle.
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Causes[edit]
Unable to connect to cisco anyconnect. Among the causes of LBBB are:[2]
- Acute myocardial infarction
- Extensive coronary artery disease
- Primary disease of the cardiac electrical conduction system
- Long standing hypertension leading to aortic root dilatation and subsequent aortic regurgitation
- Side effect of some cardiac surgeries (e.g., aortic root reconstruction)
Diagnosis[edit]
Electrocardiogram showing left bundle branch block and irregular rhythm due to supraventricular extrasystoles.
A left bundle branch block
The criteria to diagnose a left bundle branch block on the electrocardiogram:[citation needed]
- The heart rhythm must be supraventricular in origin
- The QRS duration must be ≥ 120 ms[3]
- There should be a QS or rS complex in lead V1
- There should be a notched ('M'-shaped) R wave in lead V6.
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The T wave should be deflected opposite the terminal deflection of the QRS complex. This is known as appropriate T wave discordance with bundle branch block. A concordant T wave may suggest ischemia or myocardial infarction.[citation needed]
There are also partial blocks of the left bundle branch: 'left anterior fascicular block' (LAFB)[4] and a 'left posterior fascicular block' (LPFB).[5] This refers to the block after the bifurcation of the left bundle branch.
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Diagnostic consequences[edit]
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The presence of LBBB results in that electrocardiography (ECG) cannot be used to diagnose left ventricular hypertrophy or Q wave infarction, because LBBB in itself results in widened QRS complex, and changes in the ST segment consistent with ischemia or injury.[6]
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Treatment[edit]
- Patients with LBBB require complete cardiac evaluation, and those with LBBB and syncope or near-syncope may require a pacemaker.
- Some patients with LBBB, a markedly prolonged QRS (usually > 150 ms), and systolic heart failure may benefit from a biventricular pacemaker, which allows for better synchrony of heart contractions.[7]
See also[edit]
References[edit]
- ^'Conduction Blocks 2006 KCUMB'. Retrieved 2009-01-20.
- ^'Symptoms and causes - Mayo Clinic'. www.mayoclinic.org. Retrieved 2021-04-06.
- ^'Lesson VI - EKG Conduction Abnormalities'. Retrieved 2009-01-07.
- ^'more detailed information about left anterior fascicular block'. GPnotebook.
- ^'more detailed information about left posterior fascicular block'. GPnotebook.
- ^Emily Groepper; Nasar Nallamothu; Wilfred Lam; Frank Aguirre; Kristi Bergman; Patricia Good; Patricia Wright (May 13, 2014). 'Electrocardiography > Left Bundle Branch Block (LBBB)'. Southern Illinois University School of Medicine. Retrieved 2015-07-02.
- ^Stevenson WG, Hernaddez AF, Carson PE, et al. Indications for cardiac resynchronization therapy: 2011 update from the Heart Failure Society of America guideline committee. J Card Fail 2012; 18:94-106.
External links[edit]
Classification |
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External resources |
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