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Norbert M. van Hemel, Left is worse than right: the outcome of bundle branch block in middle-aged men
, European Heart Journal, Volume 26, Issue 21, November 2005, Pages 2222–2223, https://doi.org/10.1093/eurheartj/ehi390The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.
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This editorial refers to ‘Bundle branch block in middle-aged men—risk of complications and death over 28 years. The primary prevention study in Göteborg, Sweden’† by P. Eriksson et al., on page 2300
As opposed to right bundle branch block, left bundle branch block has been associated with organic heart diseases caused by high blood pressure, coronary artery disease, aortic valve stenosis, and cardiomyopathy since its first description.1 It is also known that degeneration of the specific conduction system increases with advancing age, resulting in a rise of the prevalence of bundle branch block in older individuals. In contrast, current imaging techniques and ischaemia detection sometimes rule out virtually any cardiac abnormality except abnormal regional left ventricular (LV) wall motion, specifically of the interventricular septum. Recently, resynchronization therapy with biventricular pacing has refreshed our interest in bundle branch block patterns. It has been shown that reduction of left intraventricular conduction delay with biventricular pacing contributes to improved functioning of heart failure patients by ameliorating several systolic function parameters. Despite this new knowledge, our insight into the pathophysiological relationship between left bundle branch block and organic heart disease remains superficial. For example, it is unknown whether LV dysfunction precedes left bundle branch block or whether the reversed course is the case.2 Long-term prospective observations can support our insight into this pathophysiological relationship.
