Author + information
- Received June 16, 2018
- Revision received August 22, 2018
- Accepted September 10, 2018
- Published online December 10, 2018.
- Vincent Auffret, MDa,b,c,∗ (, )@CHURennes,
- Raphaël P. Martins, MD, PhDa,b,c,
- Claude Daubert, MDb,c,
- Christophe Leclercq, MD, PhDa,b,
- Hervé Le Breton, MDa,b,c,
- Philippe Mabo, MDa,b,c and
- Erwan Donal, MD, PhDa,b,c
- aUniversité de Rennes1-Faculté de Médecine, Rennes, France
- bService de Cardiologie, Centre Hospitalier Universitaire, Rennes, France
- cLTSI-INSERM U1099, Rennes, France
- ↵∗Address for correspondence:
Dr. Vincent Auffret, Cardiology and Vascular Diseases Department, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France.
Idiopathic or iatrogenic left bundle branch block (LBBB) is a unique model of electro-mechanical ventricular dyssynchrony with concordant changes in electrical activation sequence and mechanical ventricle synchronization. In chronic animal models, isolated LBBB induces structural remodeling with progressive left ventricular (LV) dysfunction. Most abnormalities can be reverted after cardiac resynchronization therapy (CRT). In humans, 2 principal models of LBBB dyssynchronopathy can be observed: the chronic model of isolated LBBB and an acute iatrogenic model of new-onset LBBB after aortic valve interventions. Although epidemiological evidence and clinical data need to be strengthened, there is a strong presumption that they may lead to LBBB-induced cardiomyopathy and benefit from CRT to prevent progression to heart failure. A large cohort study with prospective follow-up would be required to better define actual incidence, evolution over time, and predisposing factors. Parallel randomized CRT clinical trials should be conducted in selected at-risk populations: namely, patients with persistent LBBB after transcatheter aortic valve replacement.
- cardiac resynchronization therapy
- LBBB-induced cardiomyopathy
- left bundle branch block
- left ventricular dysfunction
- mechanical dyssynchrony
- transcatheter aortic valve replacement
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received June 16, 2018.
- Revision received August 22, 2018.
- Accepted September 10, 2018.
- 2018 American College of Cardiology Foundation
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