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Bundle Branch Block

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1. Bifocal Right Ventricular PAcing in Right Bundle Branch blocK and Heart Failure With Reduced Ejection Fraction. The Study Tests the Superiority of Right Ventricular Bifocal Stimulation Over VVI Implantable Defibrillator in Right Bundle Branch Block and He

Bifocal Right Ventricular PAcing in Right Bundle Branch blocK and Heart Failure With Reduced Ejection Fraction. The Study Tests the Superiority of Right Ventricular Bifocal Stimulation Over VVI Implantable Defibrillator in Right Bundle Branch Block and He Bifocal Right Ventricular PAcing in Right Bundle Branch blocK and Heart Failure With Reduced Ejection Fraction. The Study Tests the Superiority of Right Ventricular Bifocal Stimulation Over VVI Implantable Defibrillator in Right Bundle Branch (...) Block and Heart Failure. - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Bifocal Right Ventricular PAcing in Right Bundle Branch blocK and Heart Failure With Reduced Ejection Fraction. The Study Tests

2018 Clinical Trials

2. Rationale and design for ENHANCE CRT: QLV implant strategy for non-left bundle branch block patients. (Full text)

Rationale and design for ENHANCE CRT: QLV implant strategy for non-left bundle branch block patients. Historically, cardiac resynchronization therapy (CRT) response in non-left bundle branch block (non-LBBB) patients has been suboptimal in comparison with that observed in left bundle branch block patients. The electrical activation pattern of the left ventricle (LV) is different between these two QRS morphologies. Small non-randomized studies have suggested that targeting the LV wall

2019 ESC heart failure PubMed

3. A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB).

A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). Dr. Smith's ECG Blog: A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). Thursday, February 28, 2019 A patient arrived after PEA arrest, with ROSC after intubation and chest compressions. Here is the initial 12-lead ECG: What is the appropriate therapy? This ECG is all but diagnostic of hyperkalemia. There is an irregular, slow, wide complex rhythm. Is it ventricular escape? (no, because (...) it is irregular and there appear to be conduced P-waves). Or atrial fib with slow ventricular response? (no, because it is irregular and there appear to be conducted P-waves). Because you can see some conducted atrial activity in lead II across the bottom, you know that it is of supraventricular origin. So then it is clear that there is Right Bundle branch block (RBBB). However, it is extremely wide (the computer measured it at 193 ms, and I think this is correct), much wider than RBBB should be. Also, you

2019 Dr Smith's ECG Blog

4. Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG?

Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG? Dr. Smith's ECG Blog: Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG? Sunday, January 20, 2019 An elderly patient had a pre-procedure ECG (ECG-1). She was asymptomatic. The patient had known Left Bundle Branch Block (LBBB) and atrial fibrillation (see ECG-2 below), and was rate controlled on metoprolol. ECG-1 What is the problem? ECG (...) causes life threatening dysrhythmias. At exactly what level one is at risk of such dysrhythmia is uncertain, but certainly any K below 2.0 is life threatening. Probably under 2.5 is life threatening. I believe that any hypokalemia that results in ECG abnormalities such as large U-waves, long QT, or ST-T abnormalities is potentially life threatening. There are few reports of AV block due to hypokalemia, but it has been described. It is also rare to see U-waves in the setting of LBBB. Two case reports

2019 Dr Smith's ECG Blog

5. The Effect of PR interval Prolongation on Long term Outcomes in Patients with Left Bundle Branch Block vs. Non-Left Bundle Branch Block Morphologies Undergoing Cardiac Resynchronization Therapy. (PubMed)

The Effect of PR interval Prolongation on Long term Outcomes in Patients with Left Bundle Branch Block vs. Non-Left Bundle Branch Block Morphologies Undergoing Cardiac Resynchronization Therapy. Although the influence of QRS duration (QRSd) and/or bundle branch block morphology on outcomes of cardiac resynchronization therapy (CRT) have been well studied, the effect of PR interval remains uncertain.The purpose of this study was to evaluate the impact of PR prolongation (PRp) before CRT on long (...) -term outcomes, specifically taking into account bundle branch block morphology and QRSd.We extracted clinical data on consecutive patients undergoing CRT. Multivariate models were constructed to analyze the effect of PRp (≥200 ms) on the combined endpoint of death, heart transplant, or left ventricular assist device. Kaplan-Meier curves were constructed stratifying patients based on bundle branch block and QRSd (dichotomized by 150 ms).Of the 472 patients who met inclusion criteria, 197 (41.7%) had

2017 Heart Rhythm

6. Diagnosis of acute myocardial infarction in the presence of left bundle branch block

Diagnosis of acute myocardial infarction in the presence of left bundle branch block Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician.We prospectively evaluated the incidence of AMI and diagnostic performance of specific ECG and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three

2019 EvidenceUpdates

7. Intracardiac Delineation of Septal Conduction in Left Bundle Branch Block Patterns: Mechanistic Evidence of Left Intra-Hisian Block Circumvented by His Pacing. (PubMed)

Intracardiac Delineation of Septal Conduction in Left Bundle Branch Block Patterns: Mechanistic Evidence of Left Intra-Hisian Block Circumvented by His Pacing. Septal activation in patients with left bundle branch block patterns has not been previously described. We performed detailed intracardiac mapping of left septal conduction to assess for the presence and level of complete conduction block in the His-Purkinje system. Response to His pacing was assessed in patients with and without (...) complete conduction block in the left bundle.Left septal mapping was performed with a linear multielectrode catheter in consecutive patients with LBBB pattern referred for device implant (n=38) or substrate mapping (n=47). QRS width, His duration, HV intervals, and septal conduction patterns were analyzed. The site of complete conduction block (CCB) was localized to the level of the left-sided His fibers (left intra-hisian) or left bundle branch (LBB). Patients with ventricular activation preceded

2019 Circulation

8. Right Bundle Branch Block and ST Depression in V1-V3. Is that normal? And a complication.

Right Bundle Branch Block and ST Depression in V1-V3. Is that normal? And a complication. Dr. Smith's ECG Blog: Right Bundle Branch Block and ST Depression in V1-V3. Is that normal? And a complication. Saturday, February 24, 2018 A late middle-aged male with h/o 3 vessel bypass (CABG), type 2 diabetes, peripheral vascular disease, DVT, Chronic Kideny Disease, and chronic combined systolic and diastolic congestive heart failure presented with chest pain which started approximately 2 hours (...) prior to arrival. Here was the initial ED ECG: Sinus Rhythm There is an rSR' in V1, with wide S-waves in lateral leads (right bundle branch block, RBBB). Normally, RBBB has a bit of ST depression in V1-V3 that is discordant (in the opposite direction of) the R'-wave. So that bit of ST Depression in V1 is normal. What about V2 and V3? Notice there is no R'-wave in V2 and V3!! This happens in some RBBB when there is very early transition. Normally, in RBBB, there is indeed an R'-wave in V1-V3. Here

2018 Dr Smith's ECG Blog

9. Is this just right bundle branch block?

Is this just right bundle branch block? Dr. Smith's ECG Blog: Is this just right bundle branch block? Monday, April 16, 2018 This ECG was texted to me with the text: "There is a history of RBBB but we do not have an image to compare this with. I interpret as RBBB with atrial fib. Anything else?" What was my response? The QRS duration is long: the computer measured it at 212 ms. I measured it at approximately 180 ms. Either way, it is is too long for simple RBBB. My response: "It is a pretty

2018 Dr Smith's ECG Blog

10. Left Bundle Branch Block, Severe Chest pain, Previous Normal Angio. What is going on?

Left Bundle Branch Block, Severe Chest pain, Previous Normal Angio. What is going on? Dr. Smith's ECG Blog: Left Bundle Branch Block, Severe Chest pain, Previous Normal Angio. What is going on? Monday, June 4, 2018 A middle-aged woman with idiopathic cardiomyopathy and biventricular failure, with previous EF of 15%, presented with sudden onset severe substernal chest pain . She had LBBB with a wide QRS, and therefore was a candidate for biventricular pacer for cardiac resynchronization (...) bundle branch block (LBBB) 2. The initial ECG has an inferior axis. This suggests the limb leads are reversed because, whereas the previous has a large monophasic R-wave in aVL, with a negative QRS in III, the initial ECG has the opposite. 3. This initial ECG has no evidence of ischemia. Previous normal angiogram, done to assess reason for cardiomyopathy: Minimal coronary artery disease Impression and recommendations: No epicardial coronary artery disease noted to explain advancing systolic heart

2018 Dr Smith's ECG Blog

11. Is there Wellens' syndrome in left bundle branch block? Or in inferior and lateral leads?

Is there Wellens' syndrome in left bundle branch block? Or in inferior and lateral leads? Dr. Smith's ECG Blog: Is there Wellens' syndrome in left bundle branch block? Or in inferior and lateral leads? Sunday, February 11, 2018 Written by Pendell Meyers, with edits by Steve Smith A male in his 80s old had acute onset of chest pain. Here is his first ECG, time zero: What do you think? Sinus rhythm with left bundle branch block. There is concordant STE in leads II, V5, and V6. It may not reach

2018 Dr Smith's ECG Blog

12. Automatic diagnosis of strict left bundle branch block using a wavelet-based approach. (Full text)

Automatic diagnosis of strict left bundle branch block using a wavelet-based approach. Patients with left bundle branch block (LBBB) are known to have a good clinical response to cardiac resynchronization therapy. However, the high number of false positive diagnosis obtained with the conventional LBBB criteria limits the effectiveness of this therapy, which has yielded to the definition of new stricter criteria. They require prolonged QRS duration, a QS or rS pattern in the QRS complexes

2019 PLoS ONE PubMed

13. Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic induction by landiolol (Full text)

Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic induction by landiolol 29296582 2019 02 26 2214-0271 3 12 2017 Dec HeartRhythm case reports HeartRhythm Case Rep Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic induction by landiolol. 586-589 10.1016/j.hrcr.2017.09.006 (...) United States HeartRhythm Case Rep 101656239 2214-0271 Catheter ablation Focal ventricular tachycardia Landiolol infusion Right bundle branch 2018 1 4 6 0 2018 1 4 6 0 2018 1 4 6 1 epublish 29296582 10.1016/j.hrcr.2017.09.006 S2214-0271(17)30168-9 PMC5741816 Heart Rhythm. 2008 Jan;5(1):142-4 18055268 Am J Cardiol. 1981 Feb;47(2):315-22 7468483 Europace. 2011 Feb;13(2):292-4 20817939 Circ Arrhythm Electrophysiol. 2014 Dec;7(6):1159-67 25378469 Heart Rhythm. 2013 Aug;10(8):1234-6 22728342 Heart Rhythm

2017 HeartRhythm Case Reports PubMed

14. What is lurking underneath this new right bundle branch block?

What is lurking underneath this new right bundle branch block? Dr. Smith's ECG Blog: What is lurking underneath this new right bundle branch block? Saturday, November 25, 2017 Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. Here is her triage ECG (the baseline is not available but reportedly "normal"): What is your interpretation? There is sinus rhythm with PACs and PVCs. More important (...) , there is right bundle branch block with hyperacute concordant T-waves in V3-V6, as well as hyperacute T-waves in leads III and aVF with reciprocal ST depression in aVL. This distribution is classic for a type III "wraparound" LAD occlusion. As a general rule, right bundle branch block should usually not have any ST elevation anywhere on the ECG, and the leads with large R' waves such as leads V1 and V2 should have either baseline J-points or some slight ST depression, with negative T-waves. The rhythm

2017 Dr Smith's ECG Blog

15. His-Bundle Pacing in a Patient with Transcatheter Aortic Valve Implantation-Induced Left Bundle Branch Block (Full text)

His-Bundle Pacing in a Patient with Transcatheter Aortic Valve Implantation-Induced Left Bundle Branch Block Transcatheter aortic valve implantation (TAVI) is an effective intervention for severe aortic stenosis in patients at intermediate or high surgical risk, but damage to the native conduction system such as left bundle branch block (LBBB) may offset its benefits. New onset LBBB is associated with a higher risk of cardiovascular morbidity and mortality. His-bundle pacing (HBP) may be useful (...) of the proximal His restored AV synchrony without correction of LBBB. Repositioning of the lead with capture of the left bundle branch enabled complete ventricular resynchronisation with a single lead. Our case demonstrates that LBBB in the setting of TAVI may be corrected by HBP.

2018 Case reports in cardiology PubMed

16. Cardiac resynchronization therapy for rate-related bundle branch block: Is there a role for His-bundle pacing? (Full text)

Cardiac resynchronization therapy for rate-related bundle branch block: Is there a role for His-bundle pacing? 30364697 2019 02 26 2214-0271 4 10 2018 Oct HeartRhythm case reports HeartRhythm Case Rep Cardiac resynchronization therapy for rate-related bundle branch block: Is there a role for His-bundle pacing? 475-479 10.1016/j.hrcr.2018.07.005 Contractor Tahmeed T Loma Linda University Medical Center, Loma Linda, California. Timothy Pamela P Loma Linda University Medical Center, Loma Linda (...) , California. Pai Sudha S Loma Linda University Medical Center, Loma Linda, California. Mitchell Ingrid I Loma Linda University Medical Center, Loma Linda, California. Bhardwaj Rahul R Loma Linda University Medical Center, Loma Linda, California. Mandapati Ravi R Loma Linda University Medical Center, Loma Linda, California. eng Case Reports 2018 08 30 United States HeartRhythm Case Rep 101656239 2214-0271 Cardiac resynchronization therapy Cardiomyopathy Dyssynchrony His bundle pacing Left bundle branch

2018 HeartRhythm Case Reports PubMed

17. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. (PubMed)

Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. His bundle pacing (HBP) can potentially correct left bundle branch block (LBBB). We aimed to assess the efficacy of HBP to correct LBBB and long-term clinical outcomes with HBP in patients with heart failure (HF).This is an observational study of patients with HF with typical LBBB who were indicated for pacing therapy and were consecutively enrolled from one centre. Permanent HBP leads were

2018 Heart

18. Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block. (Full text)

Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block. Background Cardiac resynchronization therapy utilizing biventricular pacing is an effective therapy for patients with left ventricular (LV) systolic dysfunction, left bundle branch block, and heart failure. Benefits of biventricular pacing may be limited in patients with right bundle branch block (RBBB). Permanent His bundle pacing (HBP) has recently been reported (...) . Results Mean age was 72±10 years, female 15%, with an average LV ejection fraction of 31±10%. HBP was successful in 37 of 39 patients (95%) with narrowing of RBBB in 78% cases. His capture and bundle branch block correction thresholds were 1.1±0.6 V and 1.4±0.7 V at 1 ms, respectively. During a mean follow-up of 15±23 months, there was a significant narrowing of QRS from 158±24 to 127±17 ms ( P=0.0001), increase in LV ejection fraction from 31±10% to 39±13% ( P=0.004), and improvement in New York

2018 Circulation. Arrhythmia and electrophysiology PubMed

19. Mechanism of Abnormal Septal Motion in Left Bundle Branch Block: Role of Left Ventricular Wall Interactions and Myocardial Scar. (PubMed)

Mechanism of Abnormal Septal Motion in Left Bundle Branch Block: Role of Left Ventricular Wall Interactions and Myocardial Scar. This study sought to investigate how regional left ventricular (LV) function modifies septal motion in left bundle branch block (LBBB).In LBBB, the interventricular septum often has marked pre-ejection shortening, followed by immediate relengthening (rebound stretch). This motion, often referred to as septal flash, is associated with positive response to cardiac

2019 JACC. Cardiovascular imaging

20. Association of left bundle branch block with new onset abnormal wall motion in treated hypertensive patients with left ventricle hypertrophy: the LIFE Echo Sub-study. (PubMed)

Association of left bundle branch block with new onset abnormal wall motion in treated hypertensive patients with left ventricle hypertrophy: the LIFE Echo Sub-study. We aimed to investigate whether left bundle branch block (LBBB) is related to new-onset left ventricle (LV) wall motion abnormalities during treatment in hypertensive patients with electrocardiographic (ECG) defined left ventricular hypertrophy (LVH).960 patients with essential hypertension and ECG-LVH participating in the LIFE

2019 Blood pressure

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