| Abstract [eng] |
Left bundle branch block is a frequent conduction disturbance in patients with heart failure with reduced ejection fraction. Its occurrence negatively impacts clinical outcome. Although it has been historically viewed as an indicator of advanced disease, increasing evidence suggests that is also plays a direct role in disease progression. Specifically, LBBB contributes to electromechanical dyssynchrony, reduces cardiac efficiency and may result in secondary cardiac conditions, such as secondary mitral regurgitation. Purpose of this thesis is to describe the pathophysiological and clinical importance of left bundle branch block in patients with heart failure with reduced ejection fraction, especially in regard to its influence on therapeutic methods. By reviewing existing literature, relevant studies were sourced from major medical databases and analyzed with particular focus on the mechanisms behind electrical dyssynchrony, imaging results and treatment methods. The results indicate that LBBB is not only linked to more severe stages of heart failure but also plays a role in functional decline. By using multiple modalities for diagnostic techniques, including electrocardiography, echocardiography and cardiac magnetic resonance imaging, it is now possible to better understand occurring cardiac alterations and make a better risk assessment. Regarding treatment, cardiac resynchronization therapy has demonstrated to be a great method to improve ventricular synchrony, induce reverse remodeling, reduce symptoms and reduce mortality rates. Newer pacing methods like His bundle pacing and left bundle branch area pacing are emerging as promising options and aim to achieving more physiological ventricular activation patterns. In summary, these results indicate that left bundle branch block is a significant and potentially modifiable factor in the underlying mechanisms of heart failure with reduced ejection fraction. This calls future research to gain further insights into individualized treatment approaches. Future efforts should also be placed into identification of refined patient selection and possible new pacing techniques. |
