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Left bundle branch block

MedGen UID:
7286
Concept ID:
C0023211
Disease or Syndrome
Synonyms: Block, Left Bundle-Branch; Blocks, Left Bundle-Branch; Bundle-Branch Block, Left; Bundle-Branch Blocks, Left; Left Bundle Branch Block; Left Bundle-Branch Block; Left Bundle-Branch Blocks
SNOMED CT: Left bundle branch block (63467002); LBBB - Left bundle branch block (63467002)
 
HPO: HP:0011713

Definition

A conduction block of the left branch of the bundle of His. This manifests as a generalized disturbance of QRS morphology on EKG. [from HPO]

Conditions with this feature

Dilated cardiomyopathy 1C
MedGen UID:
316944
Concept ID:
C1832244
Disease or Syndrome
An autosomal dominant subtype of dilated cardiomyopathy caused by mutation(s) in the LDB3 gene, encoding LIM domain-binding protein 3.
Dilated cardiomyopathy 1E
MedGen UID:
331341
Concept ID:
C1832680
Disease or Syndrome
Any familial isolated dilated cardiomyopathy in which the cause of the disease is a mutation in the SCN5A gene.
Hypertrophic cardiomyopathy 6
MedGen UID:
331466
Concept ID:
C1833236
Disease or Syndrome
Mutations in the PRKAG2 gene (602743) give rise to a moderate, essentially heart-specific, nonlysosomal glycogenosis with clinical onset typically in late adolescence or in the third decade of life, ventricular pre-excitation predisposing to supraventricular arrhythmias, mild to severe cardiac hypertrophy, enhanced risk of sudden cardiac death in midlife, and autosomal dominant inheritance with full penetrance (summary by Burwinkel et al., 2005).
Hypertrophic cardiomyopathy 10
MedGen UID:
331754
Concept ID:
C1834460
Disease or Syndrome
Any hypertrophic cardiomyopathy in which the cause of the disease is a mutation in the MYL2 gene.
Hypertrophic cardiomyopathy 4
MedGen UID:
350526
Concept ID:
C1861862
Disease or Syndrome
Nonfamilial hypertrophic cardiomyopathy tends to be milder. This form typically begins later in life than familial hypertrophic cardiomyopathy, and affected individuals have a lower risk of serious cardiac events and sudden death than people with the familial form.\n\nWhile most people with familial hypertrophic cardiomyopathy are symptom-free or have only mild symptoms, this condition can have serious consequences. It can cause abnormal heart rhythms (arrhythmias) that may be life threatening. People with familial hypertrophic cardiomyopathy have an increased risk of sudden death, even if they have no other symptoms of the condition. A small number of affected individuals develop potentially fatal heart failure, which may require heart transplantation.\n\nThe symptoms of familial hypertrophic cardiomyopathy are variable, even within the same family. Many affected individuals have no symptoms. Other people with familial hypertrophic cardiomyopathy may experience chest pain; shortness of breath, especially with physical exertion; a sensation of fluttering or pounding in the chest (palpitations); lightheadedness; dizziness; and fainting.\n\nIn familial hypertrophic cardiomyopathy, cardiac thickening usually occurs in the interventricular septum, which is the muscular wall that separates the lower left chamber of the heart (the left ventricle) from the lower right chamber (the right ventricle). In some people, thickening of the interventricular septum impedes the flow of oxygen-rich blood from the heart, which may lead to an abnormal heart sound during a heartbeat (heart murmur) and other signs and symptoms of the condition. Other affected individuals do not have physical obstruction of blood flow, but the pumping of blood is less efficient, which can also lead to symptoms of the condition. Familial hypertrophic cardiomyopathy often begins in adolescence or young adulthood, although it can develop at any time throughout life.\n\nHypertrophic cardiomyopathy is a heart condition characterized by thickening (hypertrophy) of the heart (cardiac) muscle. When multiple members of a family have the condition, it is known as familial hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy also occurs in people with no family history; these cases are considered nonfamilial hypertrophic cardiomyopathy. 
Progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal dominant 4
MedGen UID:
350480
Concept ID:
C1864668
Disease or Syndrome
Progressive external ophthalmoplegia-4 is an autosomal dominant form of mitochondrial disease that variably affects skeletal muscle, the nervous system, the liver, and the gastrointestinal tract. Age at onset ranges from infancy to adulthood. The phenotype ranges from relatively mild, with adult-onset skeletal muscle weakness and weakness of the external eye muscles, to severe, with a multisystem disorder characterized by delayed psychomotor development, lactic acidosis, constipation, and liver involvement (summary by Young et al., 2011). For a general phenotypic description and a discussion of genetic heterogeneity of autosomal dominant progressive external ophthalmoplegia, see PEOA1 (157640).
Hypertrophic cardiomyopathy 11
MedGen UID:
436962
Concept ID:
C2677506
Disease or Syndrome
An autosomal dominant subtype of familial hypertrophic cardiomyopathy caused by mutation(s) in the ACTC1 gene, encoding actin, alpha cardiac muscle 1.
Dilated cardiomyopathy 1BB
MedGen UID:
414552
Concept ID:
C2752072
Disease or Syndrome
Dilated cardiomyopathy-1BB (CMD1BB) is a life-threatening, intractable disease characterized by ventricular dilation and thinning (Shiba et al., 2021). For a phenotypic description and a discussion of genetic heterogeneity of dilated cardiomyopathy, see CMD1A (115200).
Dilated cardiomyopathy 1V
MedGen UID:
462308
Concept ID:
C3150958
Disease or Syndrome
Any familial isolated dilated cardiomyopathy in which the cause of the disease is a mutation in the PSEN2 gene.
Hypertrophic cardiomyopathy 16
MedGen UID:
462554
Concept ID:
C3151204
Disease or Syndrome
Any hypertrophic cardiomyopathy in which the cause of the disease is a mutation in the MYOZ2 gene.
Dilated cardiomyopathy 1U
MedGen UID:
463620
Concept ID:
C3160720
Disease or Syndrome
Any familial isolated dilated cardiomyopathy in which the cause of the disease is a mutation in the PSEN1 gene.
Arrhythmogenic right ventricular dysplasia 13
MedGen UID:
816468
Concept ID:
C3810138
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy/dysplasia-13 (ARVD13) is characterized by progressive fibrofatty myocardial replacement, primarily of the right ventricle. The main clinical features are structural and functional abnormalities of the ventricles, electrocardiographic depolarization/repolarization changes, reentrant arrhythmias, and sudden death (summary by van Hengel et al., 2013).
Hypertrophic cardiomyopathy 26
MedGen UID:
934716
Concept ID:
C4310749
Disease or Syndrome
Familial cardiomyopathy caused by mutation in the FLNC gene has been described as hypertrophic, restrictive, dilated, or arrhythmogenic right ventricular cardiomyopathy. Affected individuals, especially those with dilated cardiomyopathy, are at risk for arrhythmias and sudden death. Arrhythmias without cardiomyopathy, and left ventricular noncompaction, have also been reported (Ortiz-Genga et al., 2016; Verdonschot et al., 2020).
Arrhythmogenic right ventricular dysplasia, familial, 14
MedGen UID:
1712001
Concept ID:
C5394505
Disease or Syndrome
Arrhythmogenic right ventricular cardiomyopathy/dysplasia-14 (ARVD14) is characterized by palpitations, chest pain, and presyncope. Electrocardiography shows epsilon waves, T-wave inversion across anterior leads, premature ventricular contractions, ventricular tachycardia, and left bundle branch block. Dilation of the right ventricle with hypokinesia and aneurysmal changes are seen on echocardiography. Cardiac MRI may show fibrofatty infiltration, which has been confirmed by endocardial biopsy in some patients. Sudden death may occur (Mayosi et al., 2017). For a discussion of genetic heterogeneity of ARVD, see ARVD1 (107970).

Professional guidelines

PubMed

Wu S, Chen X, Wang S, Xu L, Xiao F, Huang Z, Zheng R, Jiang L, Vijayaraman P, Sharma PS, Su L, Huang W
JACC Clin Electrophysiol 2021 Sep;7(9):1166-1177. Epub 2021 Apr 28 doi: 10.1016/j.jacep.2021.02.018. PMID: 33933414
Verdonschot JAJ, Hazebroek MR, Krapels IPC, Henkens MTHM, Raafs A, Wang P, Merken JJ, Claes GRF, Vanhoutte EK, van den Wijngaard A, Heymans SRB, Brunner HG
Circ Genom Precis Med 2020 Oct;13(5):476-487. Epub 2020 Sep 3 doi: 10.1161/CIRCGEN.120.003031. PMID: 32880476
Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD
Circulation 2019 Aug 20;140(8):e382-e482. Epub 2018 Nov 6 doi: 10.1161/CIR.0000000000000628. PMID: 30586772

Recent clinical studies

Etiology

Gilge JL, Padanilam BJ
Cardiol Clin 2023 Aug;41(3):393-397. doi: 10.1016/j.ccl.2023.03.011. PMID: 37321689
Huizar JF, Kaszala K, Tan A, Koneru J, Mankad P, Kron J, Ellenbogen KA
J Am Coll Cardiol 2023 Mar 28;81(12):1192-1200. doi: 10.1016/j.jacc.2023.01.040. PMID: 36948737Free PMC Article
Gilge JL, Padanilam BJ
Card Electrophysiol Clin 2021 Dec;13(4):685-689. Epub 2021 Sep 23 doi: 10.1016/j.ccep.2021.06.008. PMID: 34689895
Tan NY, Witt CM, Oh JK, Cha YM
Circ Arrhythm Electrophysiol 2020 Apr;13(4):e008239. Epub 2020 Mar 18 doi: 10.1161/CIRCEP.119.008239. PMID: 32186936
Merchant FM, Mittal S
J Cardiovasc Electrophysiol 2020 Jan;31(1):286-292. Epub 2019 Nov 25 doi: 10.1111/jce.14277. PMID: 31724791

Diagnosis

Gilge JL, Padanilam BJ
Cardiol Clin 2023 Aug;41(3):393-397. doi: 10.1016/j.ccl.2023.03.011. PMID: 37321689
Huizar JF, Kaszala K, Tan A, Koneru J, Mankad P, Kron J, Ellenbogen KA
J Am Coll Cardiol 2023 Mar 28;81(12):1192-1200. doi: 10.1016/j.jacc.2023.01.040. PMID: 36948737Free PMC Article
Pujol-López M, Tolosana JM, Upadhyay GA, Mont L, Tung R
Card Electrophysiol Clin 2021 Dec;13(4):671-684. doi: 10.1016/j.ccep.2021.07.005. PMID: 34689894
Tan NY, Witt CM, Oh JK, Cha YM
Circ Arrhythm Electrophysiol 2020 Apr;13(4):e008239. Epub 2020 Mar 18 doi: 10.1161/CIRCEP.119.008239. PMID: 32186936
Strauss DG, Selvester RH, Wagner GS
Am J Cardiol 2011 Mar 15;107(6):927-34. doi: 10.1016/j.amjcard.2010.11.010. PMID: 21376930

Therapy

Wang Y, Zhu H, Hou X, Wang Z, Zou F, Qian Z, Wei Y, Wang X, Zhang L, Li X, Liu Z, Xue S, Qin C, Zeng J, Li H, Wu H, Ma H, Ellenbogen KA, Gold MR, Fan X, Zou J; LBBP-RESYNC Investigators
J Am Coll Cardiol 2022 Sep 27;80(13):1205-1216. doi: 10.1016/j.jacc.2022.07.019. PMID: 36137670
Chen X, Ye Y, Wang Z, Jin Q, Qiu Z, Wang J, Qin S, Bai J, Wang W, Liang Y, Chen H, Sheng X, Gao F, Zhao X, Fu G, Ellenbogen KA, Su Y, Ge J
Europace 2022 May 3;24(5):807-816. doi: 10.1093/europace/euab249. PMID: 34718539Free PMC Article
Tan NY, Witt CM, Oh JK, Cha YM
Circ Arrhythm Electrophysiol 2020 Apr;13(4):e008239. Epub 2020 Mar 18 doi: 10.1161/CIRCEP.119.008239. PMID: 32186936
Merchant FM, Mittal S
J Cardiovasc Electrophysiol 2020 Jan;31(1):286-292. Epub 2019 Nov 25 doi: 10.1111/jce.14277. PMID: 31724791
Strauss DG, Selvester RH, Wagner GS
Am J Cardiol 2011 Mar 15;107(6):927-34. doi: 10.1016/j.amjcard.2010.11.010. PMID: 21376930

Prognosis

Ponnusamy SS, Bopanna D, Syed T, Muthu G, Kumar S
Indian Heart J 2021 Jan-Feb;73(1):117-120. Epub 2021 Jan 6 doi: 10.1016/j.ihj.2020.12.017. PMID: 33714396Free PMC Article
Sammour Y, Krishnaswamy A, Kumar A, Puri R, Tarakji KG, Bazarbashi N, Harb S, Griffin B, Svensson L, Wazni O, Kapadia SR
JACC Cardiovasc Interv 2021 Jan 25;14(2):115-134. doi: 10.1016/j.jcin.2020.09.063. PMID: 33478630
Shreenivas S, Schloss E, Choo J, Sarembock I, Lilly S, Kereiakes D
Expert Rev Cardiovasc Ther 2019 Apr;17(4):293-304. doi: 10.1080/14779072.2019.1598264. PMID: 30912984
Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, Parissis J, Laroche C, Piepoli MF, Fonseca C, Mebazaa A, Lund L, Ambrosio GA, Coats AJ, Ferrari R, Ruschitzka F, Maggioni AP, Filippatos G
Eur J Heart Fail 2017 Dec;19(12):1574-1585. Epub 2017 Apr 6 doi: 10.1002/ejhf.813. PMID: 28386917
Massoullié G, Bordachar P, Ellenbogen KA, Souteyrand G, Jean F, Combaret N, Vorilhon C, Clerfond G, Farhat M, Ritter P, Citron B, Lusson JR, Motreff P, Ploux S, Eschalier R
Am J Cardiol 2016 Mar 1;117(5):867-73. Epub 2015 Dec 13 doi: 10.1016/j.amjcard.2015.12.009. PMID: 26742470

Clinical prediction guides

Varma N
Card Electrophysiol Clin 2022 Jun;14(2):243-252. doi: 10.1016/j.ccep.2021.12.018. PMID: 35715082
McConaghy JR, Sharma M, Patel H
Am Fam Physician 2020 Dec 15;102(12):721-727. PMID: 33320506
Zegard A, Okafor O, de Bono J, Steeds R, Hudsmith L, Stegemann B, Jani A, Marshall H, Holloway B, Leyva F
Europace 2020 Jun 1;22(6):956-963. doi: 10.1093/europace/euaa008. PMID: 32285097
Auffret V, Martins RP, Daubert C, Leclercq C, Le Breton H, Mabo P, Donal E
J Am Coll Cardiol 2018 Dec 18;72(24):3177-3188. doi: 10.1016/j.jacc.2018.09.069. PMID: 30545456
Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D
Europace 2017 Aug 1;19(8):1251-1271. doi: 10.1093/europace/eux061. PMID: 28444180

Recent systematic reviews

Parlavecchio A, Vetta G, Caminiti R, Coluccia G, Magnocavallo M, Ajello M, Pistelli L, Dattilo G, Foti R, Carerj S, Della Rocca DG, Crea P, Palmisano P
Pacing Clin Electrophysiol 2023 May;46(5):432-439. Epub 2023 Apr 10 doi: 10.1111/pace.14700. PMID: 37036831
Aguiló O, Castells X, Miró Ò, Mueller C, Chioncel O, Trullàs JC
Clin Res Cardiol 2023 Aug;112(8):1020-1043. Epub 2022 Sep 18 doi: 10.1007/s00392-022-02105-z. PMID: 36116092
Cheng Y, Wang Z, Li Y, Qi J, Liu J
Pacing Clin Electrophysiol 2022 Feb;45(2):212-218. Epub 2022 Jan 17 doi: 10.1111/pace.14405. PMID: 34766359
Al Rajoub B, Noureddine S, El Chami S, Haidar MH, Itani B, Zaiter A, Akl EA
Heart Lung 2017 Mar-Apr;46(2):85-91. Epub 2016 Dec 10 doi: 10.1016/j.hrtlng.2016.11.002. PMID: 27955885
Hawkins NM, Bennett MT, Andrade JG, Virani SA, Krahn AD, Ignaszewski A, Toma M
Am J Cardiol 2015 Jul 15;116(2):318-24. Epub 2015 Apr 18 doi: 10.1016/j.amjcard.2015.04.026. PMID: 25975724

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