Left Bundle Branch Block Cardiomyopathy in an octogenarian: 4Dimensional XStrain Echocardiography assessment and review of literature
Prakash Heart Station, D-16, Nirala Nagar, Lucknow, UP, India - 226020.
Research Article
World Journal of Biology Pharmacy and Health Sciences, 2024, 17(02), 089–105.
Article DOI: 10.30574/wjbphs.2024.17.2.0043
Publication history:
Received on 21 December 2023; revised on 02 February 2024; accepted on 05 February 2024
Abstract:
Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction. LBBB may be the first manifestation of a more diffuse myocardial disease. The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns. Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it.
In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients. Advances in cardiac magnetic resonance imaging have significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of left ventricular remodeling. We are presenting an interesting case report of LBBB cardiomyopathy in an octogenarian adult who was referred to us for detailed color echocardiographic assessment.
Keywords:
LBBB; Left bundle branch block cardiomyopathy; Systolic dysfunction; Dyssynchrony cardiomyopathy
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