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European Heart Journal Advance Access originally published online on November 29, 2004
European Heart Journal 2005 26(1):91-98; doi:10.1093/eurheartj/ehi008
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Preclinical research

Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion

Kevin Vernooy1,2,*, Xander A.A.M. Verbeek1, Maaike Peschar1, Harry J.G.M. Crijns2, Theo Arts3, Richard N.M. Cornelussen1 and Frits W. Prinzen1,{dagger}

1Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
2Department of Cardiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
3Department of Biophysics, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands

Received February 25, 2004; revised July 15, 2004; accepted July 27, 2004 * Corresponding author. Tel: +31 43 3881212; fax: +31 43 3884166. E-mail address: k.vernooy{at}fys.unimaas.nl

Aims Left ventricular (LV) dilatation, hypertrophy, and septal perfusion defects are frequently observed in patients with left bundle branch block (LBBB). We investigated whether isolated LBBB causes these abnormalities.

Methods and results In eight dogs, LBBB was induced by radio frequency ablation. Two-dimensional echocardiography showed that 16 weeks of LBBB decreased LV ejection fraction (by 23±14%) and increased LV cavity volume (by 25±19%) and wall mass (by 17±16%). The LV septal-to-lateral wall mass ratio decreased by 6±9%, indicating asymmetric hypertrophy. After onset of LBBB, myocardial blood flow (MBF, fluorescent microspheres) and systolic circumferential shortening [CSsys, magnetic resonance (MR) tagging] decreased in the septum to 83±16% and –11±20% of baseline, respectively, and increased in LV lateral wall to 118±12% and 180±90% of baseline, respectively. MBF and CSsys values did not change over 16 weeks of LBBB. Changes in external mechanical work paralleled those in CSsys. Glycogen content was not significantly different between septum and LV lateral wall of LBBB hearts (16 weeks) and control samples, indicating absence of hibernation.

Conclusions The asynchronous ventricular activation during LBBB leads to redistribution of circumferential shortening and myocardial blood flow and, in the long run, LV remodelling. Septal hypoperfusion during LBBB appears to be primarily determined by reduced septal workload.

Key Words: Left bundle branch block • Remodelling • Echocardiography • Myocardial blood flow • MR tagging


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