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European Heart Journal Advance Access published online on September 5, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp372
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Left bundle branch block causes relative but not absolute septal underperfusion during exercise

Pascal Koepfli1,2,{dagger}, Christophe A. Wyss1,{dagger}, Oliver Gaemperli1, Patrick T. Siegrist1, Michael Klainguti1, Tiziano Schepis1, Mehdi Namdar1, Markus Bechir1, Tobias Hoefflinghaus1, Firat Duru2,3 and Philipp A. Kaufmann1,3,*

1 Cardiac Imaging, University Hospital, NUK C42, Raemistr. 100, CH-8091 Zurich, Switzerland
2 Arrhythmia Unit, University Hospital, Zurich, Switzerland
3 Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

Received 15 January 2009; revised 16 June 2009; accepted 18 August 2009 * Corresponding author. Tel: +41 44 255 35 55, Fax: +41 44 255 44 14, Email: pak{at}usz.ch

Aims: Left bundle branch block (LBBB) often causes septal perfusion defects in radionuclide myocardial perfusion imaging using exercise (Ex) but rarely using vasodilator stress. We studied whether this is due to an underlying structural disease inherent to spontaneous LBBB or whether it is also found in temporary LBBB induced by right ventricular pacing (PM) indicating a functional rather than a structural alteration.

Methods and results: Regional myocardial blood flow (MBF) at rest and at Ex was measured with15O-H2O and PET in 10 age-matched healthy volunteers (controls), 10 LBBB patients and 10 PM patients with right ventricular pacing off and on (PM off and PM on). Although at Ex septal MBF tended to be higher in LBBB than in controls (3.04 ± 1.18 vs. 2.27 ± 0.72 mL/min/g; P= ns), the ratio septal/lateral MBF was 19% lower in LBBB than in controls (P < 0.05). Similarly, switching PM on at Ex decreased the ratio septal/lateral MBF by 17% (P < 0.005).

Conclusion: The apparent septal perfusion defect in LBBB is mainly due to a relative lateral hyperperfusion rather than to an absolute septal flow decrease. This pattern seems to be reversibly inducible by right ventricular pacing, suggesting a functional rather than a structural alteration.

Key Words: Left bundle branch block • Pacing • Positron emission tomography • Myocardial perfusion • Exercise

{dagger} Both authors have equally contributed to this project.


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