Materiały źródłowe

• #1 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #2 Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22938-bundle-branch-block

  If you dont have symptoms or underlying conditions, you may not need treatment for bundle branch block. […] If you have symptoms such as fainting, your provider may suggest a pacemaker. A cardiac electrophysiologist (a subspecialized cardiologist, specifically trained to manage abnormal heart rhythms) places this device under the skin of your chest. Wires connected to your heart help it beat at a steady rate. […] If you have heart failure or dilated cardiomyopathy, your provider may recommend cardiac resynchronization therapy (CRT) using a biventricular pacemaker. This type of pacemaker helps both of your ventricles contract at the same time. CRT can help lessen symptoms such as shortness of breath.

• #3 Bundle branch block – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514

  Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block. […] If both bundles are blocked, the heart may beat very slowly, which can require a pacemaker. […] If both the right and the left bundles are blocked, the main complication is a complete blockage of the electric signaling from the upper to the lower chambers of the heart.

• #4 Right Bundle Branch Block – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507872/

  Generally, the isolated presence of a right bundle branch block is asymptomatic and does not require further evaluation or treatment. […] In the setting of heart failure with a low ventricular ejection fraction in combination with a right bundle branch block, cardiac resynchronization therapy is indicated. […] In patients wih CHF and RBBB, cardiac resynchronization therapy is indicated.

• #5 Right & Left Bundle Branch Block | MedStar Health

  https://www.medstarhealth.org/services/bundle-branch-block

  Most people with this condition dont feel any symptoms, and if you dont have an underlying condition thats causing it, you likely will not need treatment. […] If you dont have an additional heart condition, treatment of RBBB usually is not necessary. However, if you have an underlying condition that is causing the RBBB, you may require treatment for that condition. […] Rarely, LBBB can appear in healthy hearts and doesnt require treatment if no additional heart condition is present. […] Bundle branch block typically does not need treatment if you dont have an underlying heart condition. If you are diagnosed with another heart condition, your physician team will work with you to develop and implement a treatment plan. […] Treatments for arrhythmias, or heart rhythm disorders, such as minimally invasive procedures, implantable devices and surgery, vary based on the type and severity of your condition.

• #6 Bundle Branch Block > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/bundle-branch-block

  Treatment includes a pacemaker. […] When symptoms of a bundle branch block cause chest pain or fainting, doctors may recommend a pacemaker to restore a controlled flow of electrical activity within the heart. A pacemaker will be surgically implanted under the skin and near the heart, enabling electrical impulses to fire properly within the heart so that the left and right sides beat in unison. […] People with a left bundle branch block who dont need treatment for the condition upon diagnosis should continue to see their doctors regularly. A left bundle branch block can be a predictor of high blood pressure or other heart problems. If symptoms or complications develop, a patient may need a pacemaker. […] At Yale, we have innovative ways to treat patients with bundle branch blocks, says Mark Blitzer, MD, a Yale Medicine cardiologist and electrophysiologist. At times, traditional pacemakers are all that is required. More frequently, though, we will implant special types of pacemakers that can not only prevent the heart from going dangerously slow but also resynchronize the hearts contraction pattern. We can do this by pacing both sides of the heart at the same time or by using a new technique, where we implant the pacemaker lead directly into the hearts conduction system. In these cases, we can often make patients feels more energetic and actually make the heartbeat stronger again. At Yale, we are involved in research pushing this exciting new technology forward.

• #7 Left Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/l/left-bundle-branch-block.html

  How is left bundle branch block treated? […] In young and healthy people, left bundle branch block is rare. This condition seems to have little effect on how long you live if you have no other underlying heart problems. You may not need any treatment at all, especially when you have no other disease affecting your heart. But people without any symptoms should still undergo careful evaluation. […] […] In older people with coronary artery disease, left bundle branch block is associated with greater risk of death. This is especially true for people with heart failure. Left bundle branch block is also linked to a greater risk of death after a heart attack. […] […] Some people may have left bundle branch block for many years without any problems. But a newly diagnosed left bundle branch block may mean there is some underlying heart condition that requires prompt treatment. An aggressive evaluation may be necessary if you have new onset of a left bundle branch block. […]

• #8 Treatment of painful left bundle branch block syndrome with cardiac resynchronization therapy or right-ventricular pacing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6587066/

  Painful left bundle branch block (LBBB) syndrome is a rare disorder in which a rate-related LBBB aberration causes debilitating exertional chest discomfort. […] First-line treatment of painful LBBB is usually sinus node suppression using beta-blockers or ivabradine. Alternative therapies include cardiac resynchronization therapy or His-bundle pacing. However, in some cases, right ventricular pacing alone may be sufficient to control patient symptoms. […] The initial therapeutic strategy was aimed at suppressing sinus node function; however, both metoprolol succinate and ivabradine failed to adequately attenuate sinus rates at low doses. […] Consequently, a decision was made to proceed with a cardiac resynchronization therapy (CRT) pacemaker device implant. […] Painful LBBB is an uncommon and rarely recognized disorder usually treated with sinus node suppression or, occasionally, His-bundle pacing. However, in some cases, RV-only pacing may also be effective in controlling patients symptoms.

• #9 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #10 Right Bundle Branch Block: Symptoms, Causes, Diagnosis, Treatment

  https://www.healthline.com/health/right-bundle-branch-block

  RBBB doesnt always require treatment, especially if you dont have any underlying heart conditions. If you do have another heart condition, your doctor might suggest treating the underlying cause. […] If you have RBBB due to a heart attack with other electrical system conditions, for example, you may need a pacemaker. This is a device that emits electricity to help your heart maintain a consistent rhythm. […] If you have high blood pressure, you may need to take medication to help manage it. This will also reduce the strain on your heart. […] While treating the underlying condition might not completely get rid of RBBB, it can prevent future damage. […] If you have RBBB that needs treatment, your doctor will develop a plan that addresses the underlying cause.

• #11 Right bundle branch block – Wikipedia

  https://en.wikipedia.org/wiki/Right_bundle_branch_block

  The underlying condition may be treated by medications to control hypertension or diabetes, if they are the primary underlying cause. […] If coronary arteries are blocked, an invasive coronary angioplasty may relieve the impending RBBB.

• #12 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  The management of LBBB depends on the underlying structural heart disease or symptoms. Approaches are based on the impact of LBBB on cardiac function and its relation with specific heart diseases or clinical scenarios. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. Cardiac stress tests or anatomical imaging modalities like computed tomography coronary angiography (CTCA) may be indicated in people with CAD risk factors. […] Standard medical therapy for heart failure should be initiated and optimized as tolerated. Pharmacologic options include angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), -blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. Cardiac resynchronization therapy (CRT) is indicated in patients with sinus rhythm, NYHA functional class II, III, or ambulatory IV heart failure despite optimal medical therapy, an LVEF of 35% or less, QRS duration greater than or equal to 150 ms with LBBB morphology, and a meaningful expected survival longer than 1 year. CRT improves symptoms and quality of life and reduces mortality and hospitalization in these patients.

• #13 Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-left-bundle-branch-block-induced-dilated-articulo-S0870255124000817

  According to the 2022 AHA recommendations for HF management, first-line therapy in patients with HF with reduced EF (HFrEF) (40%) involves GDMT. These include the famous four pharmacological classes, namely angiotensin receptor-neprilysin inhibitor or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, mineralocorticoid receptor antagonist and sodium-glucose cotransporter 2 inhibitor. CRT is indicated in patients with persistent HFrEF (35%), NYHA II-IV, QRS 150 ms and LBBB, after three months of optimized GDMT. […] Several studies have shown an excellent response to CRT in patients with LBBB and DCM, as shown by LV reverse remodeling, normalization in QRS duration and improvement in LVEF. […] Strengthening this concept, a meta-analysis published in 2019 by Albakri demonstrated that patients with LBBB and DCM who were submitted to an early CRT strategy experienced significantly higher improvements in LVEF, when compared to the ones without LBBB.

• #14 Treatment of painful left bundle branch block syndrome with cardiac resynchronization therapy or right-ventricular pacing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6587066/

  Painful left bundle branch block (LBBB) syndrome is a rare disorder in which a rate-related LBBB aberration causes debilitating exertional chest discomfort. […] First-line treatment of painful LBBB is usually sinus node suppression using beta-blockers or ivabradine. Alternative therapies include cardiac resynchronization therapy or His-bundle pacing. However, in some cases, right ventricular pacing alone may be sufficient to control patient symptoms. […] The initial therapeutic strategy was aimed at suppressing sinus node function; however, both metoprolol succinate and ivabradine failed to adequately attenuate sinus rates at low doses. […] Consequently, a decision was made to proceed with a cardiac resynchronization therapy (CRT) pacemaker device implant. […] Painful LBBB is an uncommon and rarely recognized disorder usually treated with sinus node suppression or, occasionally, His-bundle pacing. However, in some cases, RV-only pacing may also be effective in controlling patients symptoms.

• #15 Painful left bundle branch block syndrome successfully treated by His-bundle pacing | BMJ Case Reports

  https://casereports.bmj.com/content/15/12/e251071

  Painful left bundle branch block (LBBB) syndrome is a rare cause of episodic chest pain associated with transient LBBB in the absence of flow-limiting coronary artery disease and myocardial ischaemia on functional testing. […] Various treatment modalities were attempted in the past, including exercise training, medical therapy with beta-blockers and calcium channel blockers or device therapy with right ventricle pacing, biventricular pacing and lately, His-bundle pacing. […] We noticed consistent response with complete resolution of chest pain in cases treated by His-bundle pacing in five reported cases in the literature. […] Beta-blocker therapy was first attempted. However, the patient could not tolerate it due to a low-resting rate which went to as low as 45 beats per minute after taking only 1.25mg of bisoprolol, and there was only minimal improvement in symptoms. We, therefore, discussed the option of conductive system pacing in the form of His-bundle pacing to abort the LBBB by pacing from a different level in the conductive system, the His-bundle. She then had a successful permanent His-bundle pacemaker.

• #16 Right bundle branch block: Symptoms, treatment, and outlook

  https://www.medicalnewstoday.com/articles/right-bundle-branch-block

  In most cases, when RBBB is present without any other symptoms or underlying health issues, it does not require additional evaluation or treatment. However, there are several situations when a person may require treatment due to the underlying cause of RBBB. […] For example, If an individual has heart failure and decreased pumping ability in combination with RBBB, doctors may suggest cardiac resynchronization therapy as treatment. […] In cases where a pulmonary embolism is present, doctors will prescribe medications such as anticoagulants to treat the blood clot. […] On the rare occasion that an individual with RBBB experiences fainting episodes or if there are other significant conduction disturbances, doctors may recommend implanting a pacemaker to help regulate the hearts rhythm. […] Consulting with a cardiologist is important for a proper diagnosis, evaluation, and personalized management.

• #17 Effects of guideline-directed medical therapy in patients with left bundle branch block-induced cardiomyopathy – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-effects-guideline-directed-medical-therapy-in-articulo-S188558572200189X

  Guideline-directed medical therapy seems to be ineffective in improving LVEF and functional class in patients with de novo heart failure and LBBB-induced cardiomyopathy. […] Based on a positive response to CRT on LVEF improvement, early CRT implantation could be a reasonable strategy for these patients. […] This is one of the first studies to analyze and demonstrate the hypothesis that the new guideline-directed medical therapy with the new pharmacological groups for heart failure would not be effective in improving LVEF or functional class in patients with LBBB-ICMP as they are unable to correct the intraventricular asynchrony generated by LBBB.

• #18 Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-left-bundle-branch-block-induced-dilated-articulo-S0870255124000817

  Together, the existing data emphasize the critical role of CRT as an effective treatment for DCM patients with LBBB. […] Despite growing evidence pointing out CRT as the cornerstone of LBBB-iDCM treatment, some challenging questions regarding medical therapy in this population are still unsolved. […] The unfavorable response to HF pharmacological therapy in these subjects may reflect the lack of a targeted approach to the pathophysiologic mechanisms underlying LBBB-iDCM development. […] More studies and randomized trials are needed to help clarify these findings, and further clarify the need for ICD in LBBB-iDCM.

• #19 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #20 Treatment for Left Bundle Branch Block | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/treatment-left-bundle-branch-block

  If you have symptoms or other heart problems, you may need treatment, such as: […] Pacemaker. A device is put into your chest to help your heart pump normally using wires placed in the heart. […] Cardiac resynchronization therapy (CRT). A special pacemaker is put into your chest with wires controlling both left and right ventricles. It helps the lower chambers of the heart (ventricles) pump normally. CRT may be used if you have heart failure and left bundle branch block.

• #21 Heart Block – BHF

  https://www.bhf.org.uk/informationsupport/conditions/arrhythmias/heart-block

  Some heart blocks do not need any treatment, while others do. The type of treatment you’ll need depends on the cause and your symptoms. […] If you’re diagnosed with second or third-degree (complete) heart block, you may need to have a pacemaker fitted. […] If you’ve got heart block that’s caused by a heart attack, you may only need a temporary pacemaker while you’re in hospital. If your heart does not come back to a normal heart rhythm shortly after your heart attack, you might need to have a permanent pacemaker fitted. […] If you have heart block due to medications or electrolyte imbalances, you’ll be monitored closely in hospital and given treatment to reverse the medications or correct the electrolyte imbalances. […] If you’re worried about your treatment or have any questions, speak to your doctor or healthcare team. They can help answer any concerns or questions that you may have.

• #22 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  If you have no underlying conditions, left bundle branch block may not be serious. […] People with heart conditions may need a pacemaker or cardiac resynchronization therapy to manage this condition. […] If you have symptoms such as fainting, your provider may recommend a pacemaker. Pacemakers are typically indicated when you have a conduction abnormality along with a LBBB. […] If you have heart failure, your provider may suggest cardiac resynchronization therapy (CRT). This type of pacemaker helps your ventricles contract at the same time. CRT can help reduce symptoms such as fatigue and shortness of breath. […] If you do have symptoms, talk to your provider about whether a pacemaker or cardiac resynchronization therapy can help you.

• #23 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #24 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  If you have no underlying conditions, left bundle branch block may not be serious. […] People with heart conditions may need a pacemaker or cardiac resynchronization therapy to manage this condition. […] If you have symptoms such as fainting, your provider may recommend a pacemaker. Pacemakers are typically indicated when you have a conduction abnormality along with a LBBB. […] If you have heart failure, your provider may suggest cardiac resynchronization therapy (CRT). This type of pacemaker helps your ventricles contract at the same time. CRT can help reduce symptoms such as fatigue and shortness of breath. […] If you do have symptoms, talk to your provider about whether a pacemaker or cardiac resynchronization therapy can help you.

• #25 Bundle branch block – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514

  Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block. […] If both bundles are blocked, the heart may beat very slowly, which can require a pacemaker. […] If both the right and the left bundles are blocked, the main complication is a complete blockage of the electric signaling from the upper to the lower chambers of the heart.

• #26 Bundle Branch Blocks (LBBB, LAFB, RBBB, Trifascicular Block) : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bundle-branch-blocks-lbbb-lafb-rbbb-trifascicular-block/

  There is no hard and fast treatment algorithm/rule about treatment of bundle branch blocks. It all depends on whether the blocks are new, or symptomatic. If the history is compatible with ACS they should be worked up and treated accordingly. Scarbossa’s criteria may help to distinguish ST elevation from appropriate discordance. […] Patients with new complete or incomplete trifascicular block may require transcutaneous or transvenous pacing in the ED for symptomatic bradycardia, and need to be seen by cardiology and an electrophysiologist for pacemaker implantation. […] Trifascicular and bifascicular with intermittent trifascicular block are both class I indications for pacemaker, and require cardiology to see. […] Do not give AV nodal blocking agents (ie. atropine) to patients with bifascicular block. These blocks are occurring distal to the AV node so AV nodal blockers will be of little use.

• #27 Right Bundle Branch Block

  https://johnshopkinshealthcare.staywellsolutionsonline.com/library/diseasesconditions/adult/134,578

  Right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. […] In people with known or suspected heart disease, right bundle branch block is associated with a greater risk of death, especially after a heart attack. […] Some people with right bundle branch block may ultimately need a permanent pacemaker, but this is rare. It is usually only necessary when a person has another conduction problem and right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #28 Right Bundle Branch Block | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/right-bundle-branch-block

  How is right bundle branch block treated? […] In healthy people without apparent heart disease, right bundle branch block does not appear to have a significant effect on mortality. You may not need any treatment at all for right bundle branch block. People without any symptoms do, however, need careful evaluation at the time of diagnosis. […] In people with known or suspected heart disease, right bundle branch block is associated with a greater risk of death, especially after a heart attack. […] Some people with right bundle branch block may ultimately need a permanent pacemaker, but this is rare. It is usually only necessary when a person has another conduction problem and right bundle branch block. […] Most people with right bundle branch block may not require treatment, but some people may eventually need a pacemaker.

• #29 Bundle Branch Block | The Texas Heart Institute®

  https://www.texasheart.org/heart-health/heart-information-center/topics/bundle-branch-block/

  In most cases, BBB does not need treatment. But patients who have bundle branch block along with another heart condition may need treatment. […] For example, if the condition develops during a heart attack, you may need a pacemaker. After a heart attack, your heart is fragile, and BBB may cause a very slow heart rhythm (bradycardia). A pacemaker helps regulate the heart’s rhythm. […] For patients with both bundle branch block and dilated cardiomyopathy, a new type of pacing called cardiac resynchronization treatment (CRT) may be used. Normally, pacemakers pace only one of the lower heart chambers (the ventricles) at a time. But CRT re-coordinates the beating of the two ventricles by pacing them at the same time. […] Even if you do not have other conditions, you should still see your doctor regularly so that he or she can be sure there are no other changes in your heart.

• #30 Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bundle-branch-block.html

  Usually no treatment is done for bundle branch blocks directly. Your doctor may address the heart disease, if it is present. […] Usually implanting a pacemaker into the heart isn’t beneficial. There are exceptions to this, however. If both bundle branches are affected and associated with a heart attack, if the block is associated with a loss of consciousness (syncope) or if you have dilated cardiomyopathy, surgically implanting a pacemaker may be helpful.

• #31 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #32 Left Bundle Branch Block | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/l/left-bundle-branch-block.html

  Some people with left bundle branch block may need a permanent pacemaker. A pacemaker helps keep the heart beating at the correct rate. This is usually only needed if you are having symptoms or have another conduction problem along with left bundle branch block. […] […] People with heart failure and left bundle branch block may need cardiac resynchronization therapy or CRT. This is a type of pacemaker therapy that helps the ventricles contract at the same time. CRT can increase the amount of blood that the heart ejects and can improve symptoms of shortness of breath and fatigue. It can improve survival.

• #33 Cardiac Resynchronisation Therapy (CRT) – Melbourne Heart Rhythm

  https://www.melbourneheartrhythm.com.au/learn/procedures/8-cardiac-resynchronisation?showall=1

  Some patients with cardiomyopathy develop an abnormality in their conduction system. The most common abnormality is a delay in the normal electrical conduction through one of the normal wires – the left bundle branch. This is known as left bundle branch block (LBBB) and is seen as a widening of the QRS (>120ms) on the 12 lead ECG. This is seen in approximately 40% of patients with cardiomyopathy. Because of the delay in conduction down the left bundle branch, the right ventricle is activated a fraction of a second earlier than the left ventricle. […] Patients with LBBB on ECG and heart failure symptoms may benefit from Cardiac Resynchronisation Therapy (CRT), this is also called a Bi-Ventricular Pacemaker. […] The aim of CRT is to restore the normal coordinated pumping action of the ventricles by overcoming the delay in electrical conduction delay caused by the left bundle branch block. This is achieved by implantation of a specialized pacemaker called a CRT device or Bi-Ventricular pacemaker.

• #34 Treatment for Left Bundle Branch Block | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/treatment-left-bundle-branch-block

  If you have symptoms or other heart problems, you may need treatment, such as: […] Pacemaker. A device is put into your chest to help your heart pump normally using wires placed in the heart. […] Cardiac resynchronization therapy (CRT). A special pacemaker is put into your chest with wires controlling both left and right ventricles. It helps the lower chambers of the heart (ventricles) pump normally. CRT may be used if you have heart failure and left bundle branch block.

• #35 Left Bundle Branch Block: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23287-left-bundle-branch-block

  If you have no underlying conditions, left bundle branch block may not be serious. […] People with heart conditions may need a pacemaker or cardiac resynchronization therapy to manage this condition. […] If you have symptoms such as fainting, your provider may recommend a pacemaker. Pacemakers are typically indicated when you have a conduction abnormality along with a LBBB. […] If you have heart failure, your provider may suggest cardiac resynchronization therapy (CRT). This type of pacemaker helps your ventricles contract at the same time. CRT can help reduce symptoms such as fatigue and shortness of breath. […] If you do have symptoms, talk to your provider about whether a pacemaker or cardiac resynchronization therapy can help you.

• #36 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  The management of LBBB depends on the underlying structural heart disease or symptoms. Approaches are based on the impact of LBBB on cardiac function and its relation with specific heart diseases or clinical scenarios. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. Cardiac stress tests or anatomical imaging modalities like computed tomography coronary angiography (CTCA) may be indicated in people with CAD risk factors. […] Standard medical therapy for heart failure should be initiated and optimized as tolerated. Pharmacologic options include angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), -blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. Cardiac resynchronization therapy (CRT) is indicated in patients with sinus rhythm, NYHA functional class II, III, or ambulatory IV heart failure despite optimal medical therapy, an LVEF of 35% or less, QRS duration greater than or equal to 150 ms with LBBB morphology, and a meaningful expected survival longer than 1 year. CRT improves symptoms and quality of life and reduces mortality and hospitalization in these patients.

• #37 Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-left-bundle-branch-block-induced-dilated-articulo-S0870255124000817

  According to the 2022 AHA recommendations for HF management, first-line therapy in patients with HF with reduced EF (HFrEF) (40%) involves GDMT. These include the famous four pharmacological classes, namely angiotensin receptor-neprilysin inhibitor or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, mineralocorticoid receptor antagonist and sodium-glucose cotransporter 2 inhibitor. CRT is indicated in patients with persistent HFrEF (35%), NYHA II-IV, QRS 150 ms and LBBB, after three months of optimized GDMT. […] Several studies have shown an excellent response to CRT in patients with LBBB and DCM, as shown by LV reverse remodeling, normalization in QRS duration and improvement in LVEF. […] Strengthening this concept, a meta-analysis published in 2019 by Albakri demonstrated that patients with LBBB and DCM who were submitted to an early CRT strategy experienced significantly higher improvements in LVEF, when compared to the ones without LBBB.

• #38 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  The management of LBBB depends on the underlying structural heart disease or symptoms. Approaches are based on the impact of LBBB on cardiac function and its relation with specific heart diseases or clinical scenarios. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. Cardiac stress tests or anatomical imaging modalities like computed tomography coronary angiography (CTCA) may be indicated in people with CAD risk factors. […] Standard medical therapy for heart failure should be initiated and optimized as tolerated. Pharmacologic options include angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), -blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. Cardiac resynchronization therapy (CRT) is indicated in patients with sinus rhythm, NYHA functional class II, III, or ambulatory IV heart failure despite optimal medical therapy, an LVEF of 35% or less, QRS duration greater than or equal to 150 ms with LBBB morphology, and a meaningful expected survival longer than 1 year. CRT improves symptoms and quality of life and reduces mortality and hospitalization in these patients.

• #39 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  The management of LBBB depends on the underlying structural heart disease or symptoms. Approaches are based on the impact of LBBB on cardiac function and its relation with specific heart diseases or clinical scenarios. […] A TTE is warranted for further evaluation of underlying structural heart disease in these individuals. Cardiac stress tests or anatomical imaging modalities like computed tomography coronary angiography (CTCA) may be indicated in people with CAD risk factors. […] Standard medical therapy for heart failure should be initiated and optimized as tolerated. Pharmacologic options include angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), -blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. Cardiac resynchronization therapy (CRT) is indicated in patients with sinus rhythm, NYHA functional class II, III, or ambulatory IV heart failure despite optimal medical therapy, an LVEF of 35% or less, QRS duration greater than or equal to 150 ms with LBBB morphology, and a meaningful expected survival longer than 1 year. CRT improves symptoms and quality of life and reduces mortality and hospitalization in these patients.

• #40 Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-left-bundle-branch-block-induced-dilated-articulo-S0870255124000817

  According to the 2022 AHA recommendations for HF management, first-line therapy in patients with HF with reduced EF (HFrEF) (40%) involves GDMT. These include the famous four pharmacological classes, namely angiotensin receptor-neprilysin inhibitor or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, mineralocorticoid receptor antagonist and sodium-glucose cotransporter 2 inhibitor. CRT is indicated in patients with persistent HFrEF (35%), NYHA II-IV, QRS 150 ms and LBBB, after three months of optimized GDMT. […] Several studies have shown an excellent response to CRT in patients with LBBB and DCM, as shown by LV reverse remodeling, normalization in QRS duration and improvement in LVEF. […] Strengthening this concept, a meta-analysis published in 2019 by Albakri demonstrated that patients with LBBB and DCM who were submitted to an early CRT strategy experienced significantly higher improvements in LVEF, when compared to the ones without LBBB.

• #41 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #42 Cardiac Resynchronisation Therapy (CRT) – Melbourne Heart Rhythm

  https://www.melbourneheartrhythm.com.au/learn/procedures/8-cardiac-resynchronisation?showall=1

  Some patients with cardiomyopathy develop an abnormality in their conduction system. The most common abnormality is a delay in the normal electrical conduction through one of the normal wires – the left bundle branch. This is known as left bundle branch block (LBBB) and is seen as a widening of the QRS (>120ms) on the 12 lead ECG. This is seen in approximately 40% of patients with cardiomyopathy. Because of the delay in conduction down the left bundle branch, the right ventricle is activated a fraction of a second earlier than the left ventricle. […] Patients with LBBB on ECG and heart failure symptoms may benefit from Cardiac Resynchronisation Therapy (CRT), this is also called a Bi-Ventricular Pacemaker. […] The aim of CRT is to restore the normal coordinated pumping action of the ventricles by overcoming the delay in electrical conduction delay caused by the left bundle branch block. This is achieved by implantation of a specialized pacemaker called a CRT device or Bi-Ventricular pacemaker.

• #43 Left bundle branch block: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/left-bundle-branch-block

  According to the National Library of Medicine (NLM), cardiac resynchronization treatment (CRT), one type of heart block therapy, can reduce death by up to 37%. […] There is currently no treatment for an LBBB. Doctors usually treat any accompanying heart condition a person may have. […] For example, a pacemaker may be an option for people who develop a heart block while having a heart attack. This can help regulate the heart rhythm, as a bundle branch block can cause bradycardia and the heart to become fragile. […] However, if a person has alternating right and left bundle branch blocks, a doctor may also recommend a pacemaker. […] Research shows that there is no specific treatment for people with LBBB. However, a person may receive treatment if they have another heart condition.

• #44 Cardiac Resynchronisation Therapy (CRT) – Melbourne Heart Rhythm

  https://www.melbourneheartrhythm.com.au/learn/procedures/8-cardiac-resynchronisation?showall=1

  Patients who will benefit from a CRT device include those with: Heart failure and moderate to severe heart failure symptoms (decreased exercise tolerance and shortness of breath), Cardiomyopathy (weakened and enlarged heart muscle), Significant left bundle branch block. […] The response to CRT can vary between patients. Published studies involving several thousand patients worldwide have demonstrated improvements in exercise tolerance, heart failure symptoms and quality of life. It often takes weeks to months for these improvements to be noticed. Unfortunately a small number of heart failure patients do not benefit from the CRT therapy.

• #45 Bundle Branch Block > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/bundle-branch-block

  Treatment includes a pacemaker. […] When symptoms of a bundle branch block cause chest pain or fainting, doctors may recommend a pacemaker to restore a controlled flow of electrical activity within the heart. A pacemaker will be surgically implanted under the skin and near the heart, enabling electrical impulses to fire properly within the heart so that the left and right sides beat in unison. […] People with a left bundle branch block who dont need treatment for the condition upon diagnosis should continue to see their doctors regularly. A left bundle branch block can be a predictor of high blood pressure or other heart problems. If symptoms or complications develop, a patient may need a pacemaker. […] At Yale, we have innovative ways to treat patients with bundle branch blocks, says Mark Blitzer, MD, a Yale Medicine cardiologist and electrophysiologist. At times, traditional pacemakers are all that is required. More frequently, though, we will implant special types of pacemakers that can not only prevent the heart from going dangerously slow but also resynchronize the hearts contraction pattern. We can do this by pacing both sides of the heart at the same time or by using a new technique, where we implant the pacemaker lead directly into the hearts conduction system. In these cases, we can often make patients feels more energetic and actually make the heartbeat stronger again. At Yale, we are involved in research pushing this exciting new technology forward.

• #46 Defining Left Bundle Branch Block Patterns in Cardiac Resynchronisation Therapy: A Return to His Bundle Recordings

  https://www.aerjournal.com/articles/defining-left-bundle-branch-block-patterns-cardiac-resynchronisation-therapy-return-his?language_content_entity=en

  Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). […] Cardiac resynchronisation therapy (CRT) via biventricular pacing has been established as the mainstay electrical pacing modality to reverse the deleterious effects of electromechanical dyssynchrony, with significant reductions in mortality and heart failure (HF) hospitalisation for patients with wide QRS, as shown in multiple randomised controlled trials. […] Research has shown that patients with LBBB are the most likely to benefit from CRT, and that patients without significant LV conduction delay, particularly those with right bundle branch (RBBB) or non-specific intraventricular conduction delay (IVCD), derive little to no benefit from biventricular pacing. […] The physiology of conduction system disease is highly individualised and requires therapy directed at the patients underlying pathophysiology; traditional LV lead placement into an available tributary of the coronary sinus might not meet the needs of an individual patient.

• #47 Painful left bundle branch block syndrome successfully treated by His-bundle pacing | BMJ Case Reports

  https://casereports.bmj.com/content/15/12/e251071

  Painful left bundle branch block (LBBB) syndrome is a rare cause of episodic chest pain associated with transient LBBB in the absence of flow-limiting coronary artery disease and myocardial ischaemia on functional testing. […] Various treatment modalities were attempted in the past, including exercise training, medical therapy with beta-blockers and calcium channel blockers or device therapy with right ventricle pacing, biventricular pacing and lately, His-bundle pacing. […] We noticed consistent response with complete resolution of chest pain in cases treated by His-bundle pacing in five reported cases in the literature. […] Beta-blocker therapy was first attempted. However, the patient could not tolerate it due to a low-resting rate which went to as low as 45 beats per minute after taking only 1.25mg of bisoprolol, and there was only minimal improvement in symptoms. We, therefore, discussed the option of conductive system pacing in the form of His-bundle pacing to abort the LBBB by pacing from a different level in the conductive system, the His-bundle. She then had a successful permanent His-bundle pacemaker.

• #48 Painful left bundle branch block syndrome successfully treated by His-bundle pacing | BMJ Case Reports

  https://casereports.bmj.com/content/15/12/e251071

  With the substantial body of evidence we have nowadays about the benefits of His-bundle pacing in preventing long-term deleterious effects of chronic dyssynchrony from RV pacing only, it has become apparent that His-bundle pacing would be a much better option for long-term treatment of painful LBBB syndrome. […] Recently, His-bundle pacing is a promising treatment strategy that is gaining popularity in treating this condition.

• #49 Defining Left Bundle Branch Block Patterns in Cardiac Resynchronisation Therapy: A Return to His Bundle Recordings

  https://www.aerjournal.com/articles/defining-left-bundle-branch-block-patterns-cardiac-resynchronisation-therapy-return-his?language_content_entity=en

  In CRT, a precise diagnosis of the level and extent of conduction system pathology could improve technology selection, lead delivery and outcomes of physiological pacing. […] His bundle pacing (HBP) is a promising method to achieve electromechanical resynchronisation, as pacing utilising this strategy recruits the intrinsic specialised conduction system. […] Until recently, the underlying mechanism of how HBP (delivered proximally in the conduction system) corrects LBBB patterns (a distal defect) had not been well understood. […] The His-SYNC pilot trial was the first multicentre randomised trial to evaluate corrective HBP in direct comparison with biventricular pacing. […] The most rigorous and physiological method to evaluate corrective HBP prospectively would be to invasively confirm disease within the left-sided His fibres or proximal LBBB with EP prior to randomisation.

• #50 Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-024-04343-3

  For patients with heart failure combined with complete left bundle branch block, cardiac resynchronization therapy is an important therapeutic method. […] After obtaining informed consent, the treatment strategy decided upon by the team was to use biventricular cardiac resynchronization therapy treatment and to not intervene for the atrial tachycardia, with left bundle branch area pacing as a backup. […] For patients with heart failure combined with left bundle branch block and atrial tachycardia, left bundle branch area pacing can replace traditional biventricular pacing for cardiac resynchronization therapy treatment, and the therapeutic effect is significant. […] The preferred treatment strategy is atrial tachycardia radiofrequency ablation, CRT, or both. […] Therefore, the authors suggest that a better treatment strategy than that of this case is as follows: first, attempt cardioversion with overspeed suppression or medication during the procedure; then, if the LBBB disappears under sinus rhythm, choose the radiofrequency ablation plan for atrial tachycardia; and if the LBBB remains after cardioversion, choose the CRT plan.

• #51 Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-024-04343-3

  At present, LBBAP is a safe and effective alternative to biventricular CRT, and whether it can be used as the main treatment method still requires multicenter randomized controlled studies and further evaluation of long-term prognosis. […] For patients with heart failure combined with LBBB and atrial tachycardia, LBBAP can replace traditional biventricular pacing for CRT treatment, and the therapeutic effect is significant.

• #52 Late-Breaking Clinical Trials at Heart Rhythm 2025 Showcase Promising Outcomes for Left Bundle Branch Area Pacing in Heart Failure Treatment – HRS

  https://www.hrsonline.org/news/lcbt-showcase-promising-outcomes-left-bundle-branch-area-pacing/

  Findings from two late-breaking clinical trials demonstrate the safety and efficacy of left bundle branch area pacing (LBBAP), adding to the growing body of evidence supporting new pacing methods. […] LBBAP continues to gain attention as a promising pacing option in patients with more complex conduction system diseases, particularly for patients with infranodal atrioventricular block and left bundle branch block. […] Our findings support the hypothesis that targeting the conduction system through left bundle branch area pacing leads to superior electrical resynchronization, resulting in better clinical outcomes, said Pugazhendhi Vijayaraman, MD, Director of Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania. […] The OmniaSecure lead demonstrated high defibrillation success in LBBAP for patients indicated for an ICD or CRT-D. […] The positive defibrillation results are encouraging and highlight the potential versatility of the OmniaSecure lead, said Dr. Vijayaraman.

• #53 Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-left-bundle-branch-block-induced-dilated-articulo-S0870255124000817

  Left bundle branch block (LBBB) is a frequent finding in patients with heart failure (HF), particularly in those with dilated cardiomyopathy (DCM). […] However, a total recovery of left ventricular (LV) function after cardiac resynchronization therapy (CRT), observed in patients with LBBB and DCM, has led to increasing acknowledgement of LBBB-induced dilated cardiomyopathy (LBBB-iDCM) as a specific pathological entity. Its recognition has important clinical implications, as LBBB-iDCM patients may benefit from an early CRT strategy rather than medical HF therapy only. […] At present, there are no definitive diagnostic criteria enabling the universal identification of LBBB-iDCM, and no defined therapeutic approach in this subgroup of patients. This review compiles the main findings about LBBB-iDCM pathophysiology and the current proposed diagnostic criteria and therapeutic approach.

• #54 LB-NICM: New Approach | AER Journal

  https://www.aerjournal.com/articles/left-bundle-branch-block-associated-cardiomyopathy-new-approach?language_content_entity=en

  Left bundle branch block (LBBB) is frequently associated with structural heart disease, and predicts higher rates of morbidity and mortality. […] Current guidelines recommend cardiac resynchronisation therapy (CRT) after 3 months of medical therapy. […] Studies have suggested that medical therapy alone would be less effective, and the majority of patients would still need CRT at the end of 3 months. […] Conversely, CRT trials have shown better results and favourable clinical outcomes in patients with LBBB. […] In the absence of any other known aetiology, LBBB-associated cardiomyopathy represents a potentially reversible form of cardiomyopathy, with the majority of the patients having reverse remodelling after CRT by left bundle branch pacing. […] Given the data from CRT trials suggesting patients with LBBB and HF derived maximum benefit compared with those with non-LBBB, and the presence of a baseline LBBB is one of the strongest predictors of superresponse to CRT therapy, it is essential to understand the complex relationship between LBBB and cardiomyopathy.

• #55 LB-NICM: New Approach | AER Journal

  https://www.aerjournal.com/articles/left-bundle-branch-block-associated-cardiomyopathy-new-approach?language_content_entity=en

  Delaying CRT beyond 9 months from the time of diagnosis may miss a critical period to halt and reverse progressive myocardial damage. […] Another prospective study involving NICM patients showed the presence of LBBB as a negative marker of LV reverse remodelling with GDMT alone. […] On the contrary, CRT offers a better outcome in patients with baseline LBBB morphology compared with those with non-LBBB morphology. […] The presence of LBBB is considered as one of the markers of super-response to CRT. […] Given the fixed/progressive nature of the conduction disease and high percentage of super-response to CRT, patients with LB-NICM should be considered for early implantation of CRT to avoid progressive myocardial damage. […] LBBP provides superior electrical and mechanical resynchronisation, with nearly three-quarters of patients having reverse remodelling of the left ventricle.

• #56 LB-NICM: New Approach | AER Journal

  https://www.aerjournal.com/articles/left-bundle-branch-block-associated-cardiomyopathy-new-approach?language_content_entity=en

  Delaying CRT beyond 9 months from the time of diagnosis may miss a critical period to halt and reverse progressive myocardial damage. […] Another prospective study involving NICM patients showed the presence of LBBB as a negative marker of LV reverse remodelling with GDMT alone. […] On the contrary, CRT offers a better outcome in patients with baseline LBBB morphology compared with those with non-LBBB morphology. […] The presence of LBBB is considered as one of the markers of super-response to CRT. […] Given the fixed/progressive nature of the conduction disease and high percentage of super-response to CRT, patients with LB-NICM should be considered for early implantation of CRT to avoid progressive myocardial damage. […] LBBP provides superior electrical and mechanical resynchronisation, with nearly three-quarters of patients having reverse remodelling of the left ventricle.

• #57 Treatment of painful left bundle branch block syndrome with cardiac resynchronization therapy or right-ventricular pacing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6587066/

  Painful left bundle branch block (LBBB) syndrome is a rare disorder in which a rate-related LBBB aberration causes debilitating exertional chest discomfort. […] First-line treatment of painful LBBB is usually sinus node suppression using beta-blockers or ivabradine. Alternative therapies include cardiac resynchronization therapy or His-bundle pacing. However, in some cases, right ventricular pacing alone may be sufficient to control patient symptoms. […] The initial therapeutic strategy was aimed at suppressing sinus node function; however, both metoprolol succinate and ivabradine failed to adequately attenuate sinus rates at low doses. […] Consequently, a decision was made to proceed with a cardiac resynchronization therapy (CRT) pacemaker device implant. […] Painful LBBB is an uncommon and rarely recognized disorder usually treated with sinus node suppression or, occasionally, His-bundle pacing. However, in some cases, RV-only pacing may also be effective in controlling patients symptoms.

• #58 Painful left bundle branch block syndrome successfully treated by His-bundle pacing | BMJ Case Reports

  https://casereports.bmj.com/content/15/12/e251071

  Painful left bundle branch block (LBBB) syndrome is a rare cause of episodic chest pain associated with transient LBBB in the absence of flow-limiting coronary artery disease and myocardial ischaemia on functional testing. […] Various treatment modalities were attempted in the past, including exercise training, medical therapy with beta-blockers and calcium channel blockers or device therapy with right ventricle pacing, biventricular pacing and lately, His-bundle pacing. […] We noticed consistent response with complete resolution of chest pain in cases treated by His-bundle pacing in five reported cases in the literature. […] Beta-blocker therapy was first attempted. However, the patient could not tolerate it due to a low-resting rate which went to as low as 45 beats per minute after taking only 1.25mg of bisoprolol, and there was only minimal improvement in symptoms. We, therefore, discussed the option of conductive system pacing in the form of His-bundle pacing to abort the LBBB by pacing from a different level in the conductive system, the His-bundle. She then had a successful permanent His-bundle pacemaker.

• #59 Left Bundle Branch Block | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18700

  Patients with new-onset LBBB post-TAVR or surgical myomectomy should have continuous telemetry monitoring for at least 48 to 72 hours to detect any episodes of high-grade atrioventricular block or symptomatic bradycardia. Longer monitoring may be warranted in patients with other risk factors for conduction abnormalities, such as preexisting right bundle branch block or prolonged PR interval. […] High-risk patients, especially those with symptomatic conduction abnormalities or evidence of high-grade atrioventricular block, should receive a permanent pacemaker.

• #60 Pediatric Right Bundle Branch Block Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/894927-treatment

  The only treatment required for isolated right bundle branch block (RBBB) is periodic follow-up and evaluation. Individuals with RBBB and selected heart disease (untreated or following surgical treatment) may require an annual or biennial electrocardiography (ECG) to evaluate for interval changes. […] Inpatient ECG telemetry may be required if patients with right bundle branch block are at risk for clinically significant arrhythmia (see History and Physical Examination). […] Children with right bundle branch block should be referred to a pediatric cardiologist for careful and complete evaluation. If right bundle branch block is associated with a syndrome, consultation with other appropriate specialists is indicated.

• #61 Treatment for Left Bundle Branch Block

  https://healthlibrary.vidanthealth.com/Library/HealthSheets/3,S,90541

  Possible complications of left bundle branch block […] People with no symptoms and no other heart problems are unlikely to have complications. In other cases, complications may include: […] Heart failure […] Dizziness or fainting from low heart rate called heart block […] Heart that stops beating (cardiac arrest) […] Living with left bundle branch block […] You can help manage your condition. Make sure to: […] Tell all of your healthcare providers you have this heart condition. […] Tell your healthcare provider if you’re prescribed new medicines, especially heart-related ones. […] Tell your healthcare provider about all medicines you take, including prescription and over-the-counter medicines, vitamins, herbs, supplements, and illegal drugs. […] Keep track of your symptoms carefully.

• #62 Treatment for Left Bundle Branch Block

  https://healthlibrary.vidanthealth.com/Library/HealthSheets/3,S,90541

  See your healthcare provider regularly, even if you dont have symptoms. […] Control your cholesterol, blood sugar, and blood pressure levels. […] Eat heart-healthy foods. […] Limit the amount of salt in your diet. […] Be physically active. […] Quit smoking, if you smoke. […] When to call 911 […] Call 911 if you have any of these: […] Chest pain […] Fainting […] Severe trouble breathing […] When to call your healthcare provider […] Call your healthcare provider if you have either of these: […] Symptoms that get worse […] New symptoms

• #63 Right bundle branch block medical therapy – wikidoc

  https://www.wikidoc.org/index.php/Right_bundle_branch_block_medical_therapy

  In general treatment for right bundle branch block is not necessary. These patients need not limit their activity. However, if the RBBB progresses to heart block, the patient may be at risk for adverse clinical outcomes. […] Patients with asymptomatic right bundle branch block do not require any treatment. However, if the right bundle branch block is accompanied by second degree or third degree heart block along with symptoms like syncope, implantation of a pacemaker is necessary. […] There is insufficient evidence to prove that cardiac resynchronization therapy is effective as a management plan for right bundle branch block, as opposed to the left bundle branch block. […] Right heart catheterization in patients with already existing left bundle branch block, can lead to development of complete heart block as a complication if RBBB develops. Hence catheter insertion of right heart in those with LBBB should be done with preparation for immediate transcutaneous pacing. […] Right bundle branch block is considered an absolute contraindication to the use of the following medications: Flecainide.

• #64 Right bundle branch block, bifascicular block – Patient Care – EMT City

  https://www.emtcity.com/topic/18476-right-bundle-branch-block-bifascicular-block/

  Bifascicular block is going to show up as a combination of two blocks on the twelve lead. Leads I,II,III will help you determine if you have a hemiblock. In your case combining the hemiblock with the RBBB gives you a Bifascicular block. Bifascicular blocks are a contraindication of Lidocaine so it is important to be able to determine them. […] A Bifascicular block represents a serious conduction problem for the heart. In a bifascicular block, 2 out of 3 pathways to contract the ventricles in an organized fashion have been blocked. This can compromise myocardial contractility. […] Preparing For the Symptomatic Patient with A Bifascicular Block: The patient is much sicker than an uncomplicated MI. They may go into complete heart block suddenly and without warning. They may drop their blood pressure precipitously, especially if the QRS is 170ms. If so remember the three things to do before you give nitro and ask how much they weigh! They may just go into V-Fib or VT without warning. Anti-arrhythmia drugs are contraindicated in cases of PVCs or transient tachyarrhythmia. Treat the cause of the arrhythmia! […] I think he may be getting a defib/pacemaker placed in a day or so.

• #65 Treatment for Left Bundle Branch Block

  https://healthlibrary.vidanthealth.com/Library/HealthSheets/3,S,90541

  See your healthcare provider regularly, even if you dont have symptoms. […] Control your cholesterol, blood sugar, and blood pressure levels. […] Eat heart-healthy foods. […] Limit the amount of salt in your diet. […] Be physically active. […] Quit smoking, if you smoke. […] When to call 911 […] Call 911 if you have any of these: […] Chest pain […] Fainting […] Severe trouble breathing […] When to call your healthcare provider […] Call your healthcare provider if you have either of these: […] Symptoms that get worse […] New symptoms

• #66 Bundle Branch Block: Types, Symptoms, Treatment and More

  https://www.verywellhealth.com/bundle-branch-block-bbb-1745219

  Abnormal heart rhythm caused by bundle branch block can be diagnosed with an electrocardiogram (ECG) or echocardiogram. Treatment of the disorder may be unnecessary, but in severe cases a pacemaker and/or management of underlying heart disease may be required. […] Most of the time, bundle branch block does not require treatment. However, you and your healthcare provider will have to discuss your condition and determine whether your symptoms (if you have any) are caused by bundle branch block or another health condition, such as heart disease. […] Occasionally, a severe bundle branch block may require the surgical placement of a pacemaker to prevent episodes of complete heart block. […] In addition, significant heart failure accompanied by left bundle branch block may be treated with implantation of a cardiac resynchronization therapy (CRT) device. CRT is a specialized pacemaker that re-coordinates the beating of the two ventricles and can improve cardiac efficiency in some situations. […] Also, if you have another type of heart disease along with your conduction block, the associated heart condition typically needs to be treated.

• #67 Bundle branch block | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/bundle-branch-block?content_id=CON-20370499

  Most people with bundle branch block don’t have symptoms and don’t need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions. […] If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure. […] If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker. A pacemaker is a small device implanted under the skin of the upper chest. Two wires connect it to the right side of the heart. The pacemaker releases electrical impulses when needed to keep the heart beating regularly. […] If you have bundle branch block with low heart-pumping function, you may need cardiac resynchronization therapy (biventricular pacing). This treatment is similar to having a pacemaker implanted. But you’ll have a third wire connected to the left side of your heart so the device can keep both sides in proper rhythm. Cardiac resynchronization therapy helps the heart’s chambers squeeze (contract) in a more organized and efficient way.

• #68 Bundle Branch Block > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/bundle-branch-block

  Treatment includes a pacemaker. […] When symptoms of a bundle branch block cause chest pain or fainting, doctors may recommend a pacemaker to restore a controlled flow of electrical activity within the heart. A pacemaker will be surgically implanted under the skin and near the heart, enabling electrical impulses to fire properly within the heart so that the left and right sides beat in unison. […] People with a left bundle branch block who dont need treatment for the condition upon diagnosis should continue to see their doctors regularly. A left bundle branch block can be a predictor of high blood pressure or other heart problems. If symptoms or complications develop, a patient may need a pacemaker. […] At Yale, we have innovative ways to treat patients with bundle branch blocks, says Mark Blitzer, MD, a Yale Medicine cardiologist and electrophysiologist. At times, traditional pacemakers are all that is required. More frequently, though, we will implant special types of pacemakers that can not only prevent the heart from going dangerously slow but also resynchronize the hearts contraction pattern. We can do this by pacing both sides of the heart at the same time or by using a new technique, where we implant the pacemaker lead directly into the hearts conduction system. In these cases, we can often make patients feels more energetic and actually make the heartbeat stronger again. At Yale, we are involved in research pushing this exciting new technology forward.

• #69 Defining Left Bundle Branch Block Patterns in Cardiac Resynchronisation Therapy: A Return to His Bundle Recordings

  https://www.aerjournal.com/articles/defining-left-bundle-branch-block-patterns-cardiac-resynchronisation-therapy-return-his?language_content_entity=en

  With regard to non-invasive evaluation, there is a need to develop novel criteria to determine the presence of complete conduction block into the left bundle, as these patients are more likely to benefit from resynchronisation strategies (either biventricular pacing or HBP). […] The evolution and re-emergence of HBP provides more options for CRT and marks a return to much needed emphasis on the physiology and pathophysiology of the conduction system.

• #70 Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-left-bundle-branch-block-induced-dilated-articulo-S0870255124000817

  Left bundle branch block (LBBB) is a frequent finding in patients with heart failure (HF), particularly in those with dilated cardiomyopathy (DCM). […] However, a total recovery of left ventricular (LV) function after cardiac resynchronization therapy (CRT), observed in patients with LBBB and DCM, has led to increasing acknowledgement of LBBB-induced dilated cardiomyopathy (LBBB-iDCM) as a specific pathological entity. Its recognition has important clinical implications, as LBBB-iDCM patients may benefit from an early CRT strategy rather than medical HF therapy only. […] At present, there are no definitive diagnostic criteria enabling the universal identification of LBBB-iDCM, and no defined therapeutic approach in this subgroup of patients. This review compiles the main findings about LBBB-iDCM pathophysiology and the current proposed diagnostic criteria and therapeutic approach.

• #71 LB-NICM: New Approach | AER Journal

  https://www.aerjournal.com/articles/left-bundle-branch-block-associated-cardiomyopathy-new-approach?language_content_entity=en

  Left bundle branch block (LBBB) is frequently associated with structural heart disease, and predicts higher rates of morbidity and mortality. […] Current guidelines recommend cardiac resynchronisation therapy (CRT) after 3 months of medical therapy. […] Studies have suggested that medical therapy alone would be less effective, and the majority of patients would still need CRT at the end of 3 months. […] Conversely, CRT trials have shown better results and favourable clinical outcomes in patients with LBBB. […] In the absence of any other known aetiology, LBBB-associated cardiomyopathy represents a potentially reversible form of cardiomyopathy, with the majority of the patients having reverse remodelling after CRT by left bundle branch pacing. […] Given the data from CRT trials suggesting patients with LBBB and HF derived maximum benefit compared with those with non-LBBB, and the presence of a baseline LBBB is one of the strongest predictors of superresponse to CRT therapy, it is essential to understand the complex relationship between LBBB and cardiomyopathy.

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