Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology

Margarida Pujol-López; José M Tolosana; Gaurav A Upadhyay; Lluís Mont; Roderick Tung

doi:10.1016/j.ccep.2021.07.005

Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology

Card Electrophysiol Clin. 2021 Dec;13(4):671-684. doi: 10.1016/j.ccep.2021.07.005.

Authors

Margarida Pujol-López¹, José M Tolosana², Gaurav A Upadhyay³, Lluís Mont², Roderick Tung⁴

Affiliations

¹ Arrhythmia Section, Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Universitat de Barcelona, C/ Villarroel 170, Barcelona, Catalonia 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
² Arrhythmia Section, Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Universitat de Barcelona, C/ Villarroel 170, Barcelona, Catalonia 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain.
³ Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, The University of Chicago Medicine, Heart and Vascular Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
⁴ Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, The University of Chicago Medicine, Heart and Vascular Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA. Electronic address: rtung1@medicine.bsd.uchicago.edu.

PMID: 34689894
DOI: 10.1016/j.ccep.2021.07.005

Abstract

Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis. Recruiting the left bundle branch with conduction system pacing depends on the complex interaction between anatomy, site of pathophysiology, and delivery tools.

Keywords: Cardiomyopathy; Electromechanical dyssynchrony; Left bundle branch block; Left bundle branch pacing.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Bundle-Branch Block / therapy
Cardiac Resynchronization Therapy*
Electrocardiography
Heart Conduction System
Heart Failure* / therapy
Humans