Understanding Painful Left Bundle Branch Block Syndrome: Where Does the Evidence Lead Us?

Take home messages

• Painful left bundle branch block (LBBB) syndrome is a rare, often misdiagnosed cause of chest pain.

• Case series show limited benefit of pharmacologic therapy, whereas conduction-system pacing provides consistent symptom relief.

• Electromechanical dyssynchrony appears central to its mechanism.

• However, data remain observational. Larger, systematic investigations are needed to clarify mechanisms, validate diagnostic criteria, compare pacing strategies, and optimise long-term outcomes.

Author

  • Sub-editor:

    Dr Hnin Zaw is a cardiology registrar from the East of England Deanery with a specialist interest in electrophysiology and cardiac devices. She is currently out of programme, pursuing a PhD at Barts Heart Centre and University College London on cardiac devices. She graduated from the Medical University, Myanmar, and subsequently completed an MBA with merit at Cardiff Metropolitan University. Her doctoral research focuses on understanding the mechanisms of lead failure in cardiac implantable electronic devices (CIEDs), integrating population health records with intracardiac electrograms, and developing predictive models for premature lead failure.

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