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Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block

A subgroup of right bundle branch block (RBBB) patients may exhibit a significant left ventricular (LV) activation delay. We evaluated echocardiography in a non-ischemic heart failure patient whose QRS morphology changed from left bundle branch block (LBBB) to atypical RBBB. The septum to posterior...

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Autores principales: Hara, Hideyuki, Nagata, Takako, Ito, Hiroshi, Niwano, Shinichi, Ako, Junya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650835/
https://www.ncbi.nlm.nih.gov/pubmed/33177890
http://dx.doi.org/10.2147/IMCRJ.S269576
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author Hara, Hideyuki
Nagata, Takako
Ito, Hiroshi
Niwano, Shinichi
Ako, Junya
author_facet Hara, Hideyuki
Nagata, Takako
Ito, Hiroshi
Niwano, Shinichi
Ako, Junya
author_sort Hara, Hideyuki
collection PubMed
description A subgroup of right bundle branch block (RBBB) patients may exhibit a significant left ventricular (LV) activation delay. We evaluated echocardiography in a non-ischemic heart failure patient whose QRS morphology changed from left bundle branch block (LBBB) to atypical RBBB. The septum to posterior wall motion delay (SPWMD) measured using the M-mode was 196 ms while the patient presented with LBBB but decreased to 32 ms after the morphology changed to RBBB. These changes were also associated with delayed appearance of the septal displacement peak. Speckle tracking longitudinal strain was evaluated using three standard apical views after the morphology changed to RBBB. The LV contraction initially appeared in the basal inferior wall and there was delayed anterior wall contraction. The LV contraction pattern in our patient changed when the QRS morphology changed to atypical RBBB. A specific LV contraction sequence observed in atypical RBBB may reflect a significant LV activation delay between the inferior and anterior wall.
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spelling pubmed-76508352020-11-10 Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block Hara, Hideyuki Nagata, Takako Ito, Hiroshi Niwano, Shinichi Ako, Junya Int Med Case Rep J Case Report A subgroup of right bundle branch block (RBBB) patients may exhibit a significant left ventricular (LV) activation delay. We evaluated echocardiography in a non-ischemic heart failure patient whose QRS morphology changed from left bundle branch block (LBBB) to atypical RBBB. The septum to posterior wall motion delay (SPWMD) measured using the M-mode was 196 ms while the patient presented with LBBB but decreased to 32 ms after the morphology changed to RBBB. These changes were also associated with delayed appearance of the septal displacement peak. Speckle tracking longitudinal strain was evaluated using three standard apical views after the morphology changed to RBBB. The LV contraction initially appeared in the basal inferior wall and there was delayed anterior wall contraction. The LV contraction pattern in our patient changed when the QRS morphology changed to atypical RBBB. A specific LV contraction sequence observed in atypical RBBB may reflect a significant LV activation delay between the inferior and anterior wall. Dove 2020-11-04 /pmc/articles/PMC7650835/ /pubmed/33177890 http://dx.doi.org/10.2147/IMCRJ.S269576 Text en © 2020 Hara et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Case Report
Hara, Hideyuki
Nagata, Takako
Ito, Hiroshi
Niwano, Shinichi
Ako, Junya
Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block
title Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block
title_full Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block
title_fullStr Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block
title_full_unstemmed Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block
title_short Left Ventricular Contraction Sequence in a Case Where the QRS Changed from Left to Atypical Right Bundle Branch Block
title_sort left ventricular contraction sequence in a case where the qrs changed from left to atypical right bundle branch block
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650835/
https://www.ncbi.nlm.nih.gov/pubmed/33177890
http://dx.doi.org/10.2147/IMCRJ.S269576
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