Fujii Banyo, Takami Mistuaki
Department of Cardiology, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka-cho, Shimonoseki 759-6603, Japan.
Circ J. 2008 Jun;72(6):1030-3. doi: 10.1253/circj.72.1030.
Patients with chronic heart failure (HF) not infrequently present conduction disturbances, which are most commonly exhibited as a left bundle branch block (LBBB). LBBB is associated with intraventricular conduction delay, paradoxical septal motion, and hemodynamic deterioration, indicating an impairment of left ventricular (LV) function. However, there is controversy as to whether dilated cardiomyopathy leading to HF could develop just as a result of conduction disturbances without apparent pre-existing heart disease. We report here 2 cases of patients with non-ischemic dilated cardiomyopathy and LBBB who had complete reversal of their LV dysfunction and enlargement after cardiac resynchronization therapy, which corrects the LV activation sequence. These cases might support the idea that conduction disturbances themselves can be a principal etiology in the development of dilated cardiomyopathy.
慢性心力衰竭（HF）患者常出现传导障碍，最常见的表现为左束支传导阻滞（LBBB）。LBBB与室内传导延迟、矛盾性室间隔运动及血流动力学恶化相关，提示左心室（LV）功能受损。然而，对于导致HF的扩张型心肌病是否仅由传导障碍引起而无明显的既往心脏病，仍存在争议。我们在此报告2例非缺血性扩张型心肌病合并LBBB的患者，在心脏再同步治疗纠正LV激动顺序后，LV功能障碍和扩大完全逆转。这些病例可能支持传导障碍本身可成为扩张型心肌病发生的主要病因这一观点。
