Skip to main content
SpringerLink
Log in

Left bundle branch block and echocardiography in the era of CRT

  • Review Article
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

Left ventricular (LV) dyssynchrony is a key pathophysiology in the era of cardiac resynchronization therapy (CRT). Left bundle branch block (LBBB) is the main substrate for CRT, and understanding the electrical pathophysiology is important in assessing the effects of CRT. Three-dimensional voltage mapping systems clearly demonstrate the typical propagation pattern characterized as propagation from the mid or apical septum to the lateral or posterior wall through the apex, which appears as a U shape. The electrical characteristics in LBBB closely associate with mechanical dyssynchrony, which is visualized as a septal flash motion. This rapid motion can be detected well by M-mode, tissue Doppler, and speckle tracking imaging. However, intraventricular discoordination between the septum and free wall is also a key to the response to CRT. We classified M-mode septum images into 10 patterns and septal strain pattern into two patterns. Through detailed analysis, we found that septal contraction contributes to intraventricular coordination. Therefore, in addition to septal flash, subsequent analysis of wall motion patterns also provides additional information about myocardial contractibility and the severity of electrical dyssynchrony. Recently, 3-dimensional speckle tracking imaging was introduced and used as a novel method to image electromechanical coupling. Because activation imaging by 3-dimensional speckle tracking can visualize similar U-shaped propagation images to those by 3-dimensional voltage mapping systems, it is hoped that this method will contribute to further research. Until now, it has not been fully understood how electrical dyssynchrony is expressed as mechanical abnormalities; therefore, continuous study will be required in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61:e6–75.

    Article  PubMed  Google Scholar 

  2. Tawara S. Das Reizleitungssystem des Säugetierherzens. Eine anatomisch–histologische Studie über das Atrioventricularbundel und die Purkinjeschen Faden. Jena, Gustav Fischer, 1906. (Tawara S. The conduction system of the mammalian heart. Suma K, Shimada M, trans. London, UK: Imperial College Press, 2000).

  3. Ansari A, Ho SY, Anderson RH. Distribution of the Purkinje fibres in the sheep heart. Anat Rec. 1999;254:92–7.

    Article  CAS  PubMed  Google Scholar 

  4. Boyett MR. ‘And the beat goes on.’ The cardiac conduction system: the wiring system of the heart. Exp Physiol. 2009;94:1035–49.

    Article  CAS  PubMed  Google Scholar 

  5. Myerburg RJ, Nilsson K, Gelband H. Physiology of canine intraventricular conduction and endocardial excitation. Circ Res. 1972;30:217–43.

    Article  CAS  PubMed  Google Scholar 

  6. Vassallo JA, Cassidy DM, Marchlinski FE, et al. Endocardial activation of left bundle branch block. Circulation. 1984;69:914–23.

    Article  CAS  PubMed  Google Scholar 

  7. Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107:927–34.

    Article  PubMed  Google Scholar 

  8. Auricchio A, Fantoni C, Regoli F, et al. Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation. 2004;109:1133–9.

    Article  PubMed  Google Scholar 

  9. Duckett SG, Camara O, Ginks MR, et al. Relationship between endocardial activation sequences defined by high-density mapping to early septal contraction (septal flash) in patients with left bundle branch block undergoing cardiac resynchronization therapy. Europace. 2012;14:99–106.

    Article  PubMed  Google Scholar 

  10. Little WC, Reeves RC, Arciniegas J, et al. Mechanism of abnormal interventricular septal motion during delayed left ventricular activation. Circulation. 1982;65:1486–91.

    Article  CAS  PubMed  Google Scholar 

  11. Leenders GE, Lumens J, Cramer MJ, et al. Septal deformation patterns delineate mechanical dyssynchrony and regional differences in contractility: analysis of patient data using a computer model. Circ Heart Fail. 2012;5:87–96.

    Article  PubMed  Google Scholar 

  12. Sakamaki F, Seo Y, Atsumi A, et al. Novel dyssynchrony evaluation by M-mode imaging in left bundle branch block and the application to predict responses for cardiac resynchronization therapy. J Cardiol. 2014;64:199–206.

    Article  PubMed  Google Scholar 

  13. Søgaard P, Egeblad H, Kim WY, et al. Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. J Am Coll Cardiol. 2002;40:723–30.

    Article  PubMed  Google Scholar 

  14. Gorcsan J 3rd, Kanzaki H, Bazaz R, et al. Usefulness of echocardiographic tissue synchronization imaging to predict acute response to cardiac resynchronization therapy. Am J Cardiol. 2004;93:1178–81.

    Article  PubMed  Google Scholar 

  15. Yu CM, Zhang Q, Fung JW, et al. A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging. J Am Coll Cardiol. 2005;45:677–84.

    Article  PubMed  Google Scholar 

  16. Bax JJ, Bleeker GB, Marwick TH et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004;44:1834–40.

    Article  PubMed  Google Scholar 

  17. Chung ES, Leon AR, Tavazzi L, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation. 2008;117:2608–16.

    Article  PubMed  Google Scholar 

  18. Seo Y, Ito H, Nakatani S, et al. The role of echocardiography in predicting responders to cardiac resynchronization therapy: results from the Japan cardiac resynchronization therapy registry trial (J-CRT). Circ J. 2011;75:1156–63.

    Article  PubMed  Google Scholar 

  19. Seo Y, Ishizu T, Sakamaki F, et al. Analysis of the origin of cardiac wall motion that constitutes myocardial velocity–time curves in patients with left bundle branch block. J Am Soc Echocardiogr. 2009;22:331–6.

    Article  PubMed  Google Scholar 

  20. Miyazaki C, Lin G, Powell BD, et al. Strain dyssynchrony index correlates with improvement in left ventricular volume after cardiac resynchronization therapy better than tissue velocity dyssynchrony indexes. Circ Cardiovasc Imaging. 2008;1:14–22.

    Article  PubMed  Google Scholar 

  21. Sakamaki F, Seo Y, Ishizu T, et al. Tissue Doppler imaging dyssynchrony parameter derived from the myocardial active wall motion improves prediction of responders for cardiac resynchronization therapy. Circ J. 2012;76:689–97.

    Article  PubMed  Google Scholar 

  22. Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol. 2006;47:789–93.

    Article  PubMed  Google Scholar 

  23. Korinek J, Kjaergaard J, Sengupta PP, et al. High spatial resolution speckle tracking improves accuracy of 2-dimensional strain measurements: an update on a new method in functional echocardiography. J Am Soc Echocardiogr. 2007;20:165–70.

    Article  PubMed  Google Scholar 

  24. Kwan J. Three-dimensional echocardiography: a new paradigm shift. J Echocardiogr. 2014;12:1–11.

    Article  Google Scholar 

  25. Seo Y, Yamasaki H, Kawamura R, et al. Left ventricular activation imaging by 3-dimensional speckle-tracking echocardiography. Comparison with electrical activation mapping. Circ J. 2013;77:2481–9.

    Article  PubMed  Google Scholar 

  26. Fung JW, Chan JY, Yip GW, et al. Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy. Heart. 2007;93:432–7.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Sipahi I, Chou JC, Hyden M, et al. Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Am Heart J. 2012;163:260–7.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Seo Y, Ishizu T, Sakamaki F, et al. Mechanical dyssynchrony assessed by speckle tracking imaging as a reliable predictor of acute and chronic response to cardiac resynchronization therapy. J Am Soc Echocardiogr. 2009;22:839–46.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Yoshihiro Seo, Tomoko Ishizu, Fumiko Sakamaki, Masayoshi Yamamoto, and Kazutaka Aonuma declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan

    Yoshihiro Seo, Tomoko Ishizu, Masayoshi Yamamoto & Kazutaka Aonuma

  2. Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Japan

    Fumiko Sakamaki

Authors
  1. Yoshihiro Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomoko Ishizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fumiko Sakamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masayoshi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazutaka Aonuma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshihiro Seo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seo, Y., Ishizu, T., Sakamaki, F. et al. Left bundle branch block and echocardiography in the era of CRT. J Echocardiogr 13, 6–14 (2015). https://doi.org/10.1007/s12574-014-0233-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-014-0233-1

Keywords

Search

Navigation