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Left bundle branch block

Left bundle branch block (LBBB) is a cardiac conduction abnormality seen on the electrocardiogram (ECG).^[1] In this condition, activation of the left ventricle is delayed, which results in the left ventricle contracting later than the right ventricle.

ECG diagnosis
Causes
Treatment
Classification
See also
References
External links

ECG diagnosis

Electrocardiogram showing left bundle branch block and irregular rhythm due to supraventricular extrasystoles.

A left bundle branch block

The criteria to diagnose a left bundle branch block on the electrocardiogram:

The heart rhythm must be supraventricular in origin
The QRS duration must be = or > 120 ms^[2]
There should be a QS or rS complex in lead V1
There should be a monophasic R wave in leads I and V6.

It should be noted that LBBB renders the ST segment of chest leads unreliable.

The T wave should be deflected opposite the terminal deflection of the QRS complex. This is known as appropriate T wave discordance with bundle branch block. A concordant T wave may suggest ischemia or myocardial infarction.

A mnemonic to remember the ECG changes is WiLLiaM MaRRoW, ie with LBBB there is an W in V1 and a M in V6 and with a RBBB there is a M in lead V1 and a W in lead V6

Causes

Among the causes of LBBB are:

Aortic stenosis
Dilated cardiomyopathy
Acute myocardial infarction
Extensive cases of coronary artery disease
Primary disease of the cardiac electrical conduction system
Long standing hypertension leading to aortic root dilation and subsequent aortic regurgitation

Treatment

Medical Care: Patients with LBBB require complete cardiac evaluation, and those with LBBB and syncope or near-syncope may require a pacemaker.
Surgical Care: Some patients with LBBB, a markedly prolonged QRS, and congestive heart failure may benefit from a pacemaker, which provides rapid left ventricular contractions.

Classification

There are also partial blocks of the left bundle branch: "left anterior fascicular block" (LAFB)^[3] and a "left posterior fascicular block" (LPFB).^[4] This refers to the bifurcation of the left bundle branch.