HeartRhythm Case Reports

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HeartRhythm Case Reports

HeartRhythm Case Reports

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HeartRhythm Case Reports Treatment of painful left bundle branch block syndrome with cardiac resynchronization therapy or right-ventricular pacing Jakub Sroubek, MD, PhD, Derin Tugal, MD, Peter J. Zimetbaum, MD, FHRS, Alexei Shvilkin, MD, PhD, Alfred E. Buxton, MD HeartRhythm Case Reports DOI: 10.1016/j.hrcr.2019.03.005 Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 1 Twelve-lead electrocardiogram (ECG) obtained at rest and with minor exertion. A: Resting 12-lead ECG showed sinus rhythm at 60 bpm; there were no abnormalities. B: During minor exertion, the patient developed left bundle branch block with QRS width of 140 ms; there was borderline leftward QRS axis and there were tall T waves in the right precordial leads (S/T ratio of 1.71). The patient complained of squeezing chest pain at that time. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.03.005) Copyright © 2019 Heart Rhythm Society Terms and Conditions

Figure 2 Pacing maneuvers done approximately 1 month after cardiac resynchronization therapy pacemaker device implant. A: The patient developed left bundle branch block and associated chest pain during atrial-only pacing at 105 beats per minute (bpm) (AAI mode). B: With right atrial (RA)-left ventricular (LV) synchronous pacing at 70 bpm (DDD mode with LV-only ventricular output) there were ventricular fusion complexes; the patient had no symptoms. C: As the pacemaker base rate was increased to 105 bpm, the ventricular complexes became purely paced; at this point, the patient was aware of the elevated heart rate but he denied any chest pain. D: The device was then programmed to RA–right ventricular (RV) synchronous pacing at 105 bpm (DDD mode with RV-only ventricular output), during which the patient remained chest pain free. HeartRhythm Case Reports DOI: (10.1016/j.hrcr.2019.03.005) Copyright © 2019 Heart Rhythm Society Terms and Conditions