Treatment Strategies for Heart Failure Patients Suffering from Left Bundle Branch Block

Heart failure (HF) is a decline in the heart's ability to pump blood effectively, affecting between 1-2% of the population. This condition can lead to a range of consequences, including swelling of the lower limbs (oedema) and congestion in the liver.

When the heart fails to pump sufficient volumes of blood, it can cause a domino effect on the body. The remodeling of the left ventricle in HF is often due to the loss of synchrony between the left and right ventricles, specifically affecting the mitral valve. This desynchronisation can be exacerbated by a conduction abnormality known as left bundle branch block (LBBB).

LBBB is a conduction abnormality of the electrical impulses in the heart's left ventricle. It disrupts the synchrony of the contractions of the left and right ventricles, which is associated with an increased risk of arrhythmias and reduced ejection fraction. LBBB is typically diagnosed through an electrocardiogram (ECG), the gold standard investigation for diagnosing this condition.

Appropriate management and early intervention are essential to prevent the progression of HF and reduce hospitalization and mortality rates. Pharmacologic treatment for HF involves reducing the heart's workload and improving synchrony between the two sides of the heart.

One group of medications used in the treatment of HF with concurrent LBBB includes ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. ACE inhibitors and angiotensin receptor blockers (ARBs) aim to reduce workload on the heart and prevent further remodeling. Beta blockers improve symptoms by slowing down the heart rate, reducing the overall pressure in the heart, and reducing the risk of hospitalizations. Mineralocorticoid receptor antagonists block the release of the hormone aldosterone, which causes water retention and raised blood pressure.

The most common medications used in the treatment of HF with concurrent LBBB are bisoprolol, carvedilol, metoprolol succinate, nebivolol, spironolactone, sacubitril/valsartan, empagliflozin, dapagliflozin, and ivabradine. Ivabradine is a medication that can reverse the electrical and mechanical remodeling associated with LBBB and improve disease outcomes. Sodium-glucose transporter 2 (SGLT2) inhibitor is a medication used to control diabetes that has evidence of reducing mortality in patients with HF and diabetes.

In addition to medication, patients with HF may undergo multiple investigations, including chest x-ray, echocardiography, computed tomography, blood investigations, and cardiac magnetic resonance imaging. For some patients, more invasive treatments such as cardiac resynchronisation therapy or cardioverter defibrillators may be necessary. Cardiac resynchronisation therapy is a type of pacemaker that aims to correct the desynchronisation of the ventricles in patients with LBBB and HF and a reduced ejection fraction. Cardioverter defibrillators are devices that sit just under the skin to prevent sudden cardiac arrest by monitoring electrical abnormalities in the heart and delivering electrical shocks to restore normal rhythm.

The most common symptom reported by HF patients is shortness of breath, particularly when lying down (orthopnea). This can be managed with diuretics, also known as "water tablets", which aid with symptoms of oedema and reduce workload on the heart.

In conclusion, heart failure is a serious condition that requires prompt and appropriate treatment. With the right management, patients can reduce hospitalization and mortality rates and improve their quality of life. If you or someone you know is experiencing symptoms of heart failure, it is important to seek medical attention immediately.

Treatment Strategies for Heart Failure Patients Suffering from Left Bundle Branch Block