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Left bundle branch block

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Title: Left bundle branch block  
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Subject: Arrhythmogenic right ventricular dysplasia, Bifascicular block, Bundle branch block, ST depression, Myocardial infarction
Collection: Cardiac Dysrhythmia
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Left bundle branch block

Left bundle branch block
ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6.
Classification and external resources
Specialty Cardiology, Emergency Medicine
ICD-10 I44.4 - I44.7
DiseasesDB 7352
eMedicine ped/2501

Left bundle branch block (LBBB) is a cardiac conduction abnormality seen on the electrocardiogram (ECG).[1] In this condition, activation of the left ventricle is delayed, which causes the left ventricle to contract later than the right ventricle.

Contents

  • Causes 1
  • Diagnosis 2
    • Diagnostic consequences 2.1
  • Treatment 3
  • See also 4
  • References 5
  • External links 6

Causes

Among the causes of LBBB are:

Diagnosis

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:

  • The heart rhythm must be supraventricular in origin
  • The QRS duration must be ≥ 120 ms[2]
  • There should be a QS or rS complex in lead V1
  • There should be a notched ('M'-shaped) R wave in lead V6.

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.

There are also partial blocks of the left bundle branch: "left anterior fascicular block" (LAFB)[3] and a "left posterior fascicular block" (LPFB).[4] This refers to the bifurcation of the left bundle branch.

Diagnostic consequences

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-T segment consistent with ischemia or injury.[5]

Treatment

  • 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.[6]

See also

References

  1. ^ "Conduction Blocks 2006 KCUMB". Retrieved 2009-01-20. 
  2. ^ "Lesson VI - EKG Conduction Abnormalities". Retrieved 2009-01-07. 
  3. ^ x20050921122910832459 at GPnotebook
  4. ^ x20050921123129832459 at GPnotebook
  5. ^ Emily Groepper, Nasar Nallamothu, Wilfred Lam, Frank Aguirre, Kristi Bergman, Patricia Good, Patricia Wright (May 13, 2014). "Electrocardiography > Left Bundle Branch Block (LBBB)".  
  6. ^ 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

  • http://library.med.utah.edu/kw/ecg/mml/ecg_lbbb.html
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