Abstract

Painful Left Bundle Branch Block (LBBB) syndrome is a rare condition, defined by an exertional chest pain associated with intermittent LBBB in the absence of myocardial ischemia. The exact mechanism is still unclear. Various treatments were described, conduction system pacing such as His Bundle Pacing or Left Bundle Branch Area Pacing have proven to be most effective. The present report introduces the case of A 52-year-old male presented with a constrictive chest pain. ECG on admission showed a complete LBBB with a precordial S/T wave ratio of 2.3. Chest pain disappeared simultaneously after resolution of LBBB. Stress myocardial perfusion scan revealed an onset of chest pain concomitant with a transition to complete LBBB in the second stage, along with an aspect of myocardial ischemia. Complementary coronary angiography was normal, a negative Methergin testing eliminated the possibility of a vasospasm. Based on the above-mentioned findings we diagnosed “Painful LBBB Syndrome”. After debating all therapeutic options, The patient was initially treated with Betablockers with no improvement. Therefore, it was decided to refer him for His Bundle Pacing.

Keywords: Chest pain; Painful left bundle branch block; Myocardial ischemia; His bundle pacing