Pérez-Riera Andrés R, Barbosa-Barros Raimundo, de Rezende Barbosa Marianne P C, Daminello-Raimundo Rodrigo, de Abreu Luiz C, Nikus Kjell
Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, São Paulo, Brazil.
Coronary Center, Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil.
Ann Noninvasive Electrocardiol. 2019 Mar;24(2):e12572. doi: 10.1111/anec.12572. Epub 2018 Jun 22.
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. In this review, we will discuss the epidemiology, etiologies, and electrovectorcardiographic features of LBBB and propose a classification of the conduction disturbance.
在左束支传导阻滞（LBBB）中，心室以顺序方式被激活，同时左心室力学、灌注和负荷发生改变，从而导致心脏重塑。潜在的分子、细胞和间质变化在临床上表现为心脏大小、质量、几何形状和功能的改变。心脏重塑与进行性心室功能障碍、心律失常及预后不良相关。关于LBBB的临床和诊断观念已从单纯的心电图改变演变为影响许多患者诊断和临床管理的极其重要的发现。心脏磁共振成像的进展显著改善了对LBBB患者的评估，并为左心室重塑的病理生理机制提供了更多见解。在本综述中，我们将讨论LBBB的流行病学、病因及心电向量图特征，并提出传导障碍的分类。
