M-mode and cross-sectional echocardiographic study of the left ventricular wall motions in complete left bundle-branch block.

Abstract

SUMMARY M-mode and cross-sectional echocardiograms of 37 patients with complete left bundle-branch block were compared with those of 5 patients with complete atrioventricular block during right ventricular pacing, 20 patients with anteroseptal infarction, and 20 normal subjects.Of 37 patients with complete left bundle-branch block, 35 showed 3 types (A, B, and C) of abnormal septal motion and 2 patients showed normal septal motion. In type A and B, early and abrupt posteriorlydirected motion of the septum occurred during the pre-ejection period. After this early abnormal motion, the septum moved anteriorly in type A and posteriorly in type B. Type C exhibited akinetic or dyskinetic septal motion throughout systole. The onset of posterior wall contraction was delayed in all patients with complete left bundle-branch block.These patterns of abnormal septal motion were observed in almost all portions of upper-to mid-septum that could be recorded by cross-sectional echocardiography.Abnormal septal motion of types A and B was also observed during right ventricular pacing. It is suggested that abnormal septal motion of types A and B could be explained by asynchronous contraction of the left ventricle, with delayed activation of the left side of the septum and of the left ventricular free wall.The septal motion of type C is almost the same as that seen in patients with extensive septal infarction. Most of the patients having abnormal septal motion of type C had electrocardiographic and vectorcardiographic findings which were compatible with extensive septal infarction. Thus patients with complete left bundle-branch block and type C motion may have sufficient septal damage to prevent the early posterior motion seen in type A and B patients. Different sequence of ventricular activation will be responsible for the difference between type A and B. It is also possible that some patients with type A septal motion may have septal damage to some degree, in contrast to type B.Normal septal motion recorded in 2 patients with complete left bundle-branch block might be the result of a peripheral block of the left bundle-branch.M-mode and cross-sectional echocardiography have proved to be valuable in the study of left ventricular wall motion and the assessment of left ventricular function (Diamond et al., 1971;Jacobs et al., 1973, Fujii et al., 1976.Recently, echocardiography has disclosed a characteristic ventricular septal motion in patients with left bundle-branch block (McDonald, 1973;Dillon et al., 1974). It has been suggested that abnormal septal motion is related to an altered Received for publication 3 April 1979 sequence of activation and contraction. However, no studies have been performed to analyse the left ventricular wall motion in left bundle-branch block by cross-sectional echocardiography.The purpose of this study was (1) to analyse the motion of the interventricular septum and the left ventricular posterior wall in patients with complete left bundle-branch block by M-mode and crosssectional echocardiography; (2)...

Comparison of myocardial contrast echocardiography with SPECT in the evaluation of coronary artery disease in asymptomatic patients with LBBB

“…Finally, another well-known feature in patients with LBBB is the presence of septal wall motion abnormalities [27]. Septal hypoperfusion determined by reduced septal workload appears as the most probable causative mechanism.…”

Left Bundle Branch Block, an Old–New Entity

“…During early systole, at the time of aortic valve opening, the interventricular septum demonstrates a dorsal (posterior) motion, the extent of which may vary considerably (“septal beak”) and which is followed by abnormal anterior motion later during the ejection phase. Subsequently, Fujii et al [ 10 ] described three patterns of septal motion in 37 patients with LBBB: Types A and B presented early and abrupt posteriorly directed motion of the septum during the pre-ejection period after which the septum moved anteriorly in type A and posteriorly in type B. Type C exhibited akinetic or dyskinetic septal motion throughout systole.…”

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

“…During simultaneous right and left ventricular ejection several types of septal motion can be encountered. Classically, septal motion is anterior and described as paradoxical [11][12][13] ; however, normal posterior motion and several intermediate types may also occur [11][12][13][14][15][16] . Septal motion seems related to both contraction capability (e.g.…”

“…However, despite the use of the biphasic response [23] , the combination of impaired baseline wall thickening and left bundle branch block-induced abnormal wall motion seems to make the assessment of septal ischaemia difficult. In this respect, we anticipate that in left bundle branch block patients with septal infarction, who usually have a flat septum without wall thickening [14] , assessment of infarct-related artery patency will also be very difficult. Recently, Mairesse et al [33] reported in eight left bundle branch block patients with prior myocardial infarction and left anterior descending coronary artery stenosis a sensitivity of dobutamine-atropine stress echocardiography for the detection of coronary artery disease in the left anterior descending coronary artery of 88%.…”

“…Classically, septal motion is anterior and described as paradoxical [11][12][13] . However, normal posterior motion and several intermediate types may also occur [11][12][13][14][15][16] . Dobutamine-atropine stress echocardiography is an established stress modality for the detection of coronary artery disease in patients without left bundle branch block [17] .…”