title: Acceleration-dependent left bundle branch block with severe left ventricular dyssynchrony results in acute heart failure: are there more patients who benefit from cardiac resynchronization therapy?
abstract: Cardiac resynchronization therapy (CRT) has been proposed to improve hemodynamics in patients with heart failure and left bundle branch block (LBBB) by resynchronization of left ventricular (LV) dyssynchrony. The current report concerns a patient with narrow QRS complex without LV dyssynchrony who experienced an acute exacerbation of heart failure following exercise. Careful analysis revealed that an increase of heart rate induced acceleration-dependent LBBB with severe LV dyssynchrony and mitral regurgitation followed by acute heart failure and hemodynamic collapse. CRT prevented these adverse reactions. Accordingly, optimal evaluation for CRT may include testing for LV dyssynchrony during exercise.
authors.affiliation: Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Gabe B
authors.initials: GB
authors.lastname: Bleeker
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000208:Acute Disease; D000328:Adult; D002037:Bundle-Branch Block / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology / Q000628:therapy