Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; South Shore Hospital, South Weymouth, Massachusetts.
Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Heart Rhythm. 2016 Jan;13(1):226-32. doi: 10.1016/j.hrthm.2015.08.001. Epub 2015 Aug 30.
Painful left bundle branch block (LBBB) is a rarely diagnosed chest pain syndrome caused by intermittent LBBB in the absence of myocardial ischemia. Its prevalence, mechanism, detailed electrocardiographic (ECG) features, and effective treatments are not well described.
The purpose of this study was to characterize clinical and ECG features of patients with painful LBBB syndrome with respect to the LBBB ECG morphology (in particular QRS axis and the precordial S/T wave ratio), clarify diagnostic criteria and possible mechanisms, and provide directions for further evaluation and treatment.
We analyzed clinical (n = 50) and ECG (n = 15) features of patients with painful LBBB syndrome (4 patients in our practice and 46 cases identified in the literature).
All 15 ECGs of patients with painful LBBB syndrome had an inferior QRS axis and a very low (<1.8) precordial S/T wave ratio, which was consistent with the "new LBBB" pattern. We report a case of painful LBBB syndrome coexisting with coronary artery disease. Right ventricular apical pacing resolved intractable chest pain in 1 case of painful LBBB.
Painful LBBB ECG morphology within seconds/minutes of its onset is consistent with the new LBBB pattern with a very low (<1.8) precordial S/T wave ratio and inferior QRS axis. Painful LBBB syndrome can coexist with coronary artery disease, complicating the assessment of chest pain in the setting of LBBB. An electrophysiology study might be considered to investigate whether changing ventricular activation pattern by pacing provides consistent pain control and to select the most effective pacing configuration.
疼痛性左束支传导阻滞（LBBB）是一种罕见的胸痛综合征，由间歇性 LBBB 引起，而无心肌缺血。其患病率、机制、详细心电图（ECG）特征和有效治疗方法尚未得到很好的描述。
本研究旨在描述疼痛性 LBBB 综合征患者的临床和 ECG 特征，特别是 LBBB 心电图形态（尤其是 QRS 轴和胸前 S/T 波比值），阐明诊断标准和可能的机制，并为进一步评估和治疗提供方向。
我们分析了 50 例疼痛性 LBBB 综合征患者的临床（n=50）和心电图（n=15）特征（包括我们实践中的 4 例患者和文献中确定的 46 例患者）。
疼痛性 LBBB 综合征患者的 15 份心电图均具有下传 QRS 轴和非常低的（<1.8）胸前 S/T 波比值，与“新 LBBB”模式一致。我们报告了 1 例疼痛性 LBBB 综合征合并冠状动脉疾病的病例。1 例疼痛性 LBBB 患者采用右心室心尖部起搏后难治性胸痛得到缓解。
疼痛性 LBBB 心电图形态在其发作后的数秒/数分钟内与新的 LBBB 模式一致，胸前 S/T 波比值非常低（<1.8）且 QRS 轴向下。疼痛性 LBBB 综合征可与冠状动脉疾病共存，使 LBBB 情况下胸痛评估复杂化。可能需要进行电生理研究，以探讨通过起搏改变心室激活模式是否能提供一致的疼痛控制，并选择最有效的起搏配置。
