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Europace Advance Access originally published online on January 5, 2006
Europace 2006 8(3):151-156; doi:10.1093/europace/euj019
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

CRT

Impact of intraventricular conduction delay on coronary haemodynamics: a study with intracoronary Doppler in patients with bundle branch blocks and normal coronary arteries

Heinrich Wieneke1,*, Katherine Sattler1, Clemens von Birgelen2, Dirk Böse1, Michael Haude1, Wolfram Rechenberg1, Stefan Sack1, Nikolaos Dagres3 and Raimund Erbel1

1 Department of CardiologyUniversity Duisburg-EssenHufelandstr. 55, D-45122 Essen Germany; 2 Department of CardiologyMedisch Spectrum TwenteEnschede The Netherlands; 3 Second University Cardiology DepartmentAttikon University HospitalAthens Greece

Aims The impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) on myocardial perfusion is not completely understood as data are often blurred by underlying cardiac disease. The present study investigates whether conduction delays per se affect coronary perfusion-an indirect measure of myocardial oxygen demand.

Methods and results Intracoronary Doppler and ultrasound were performed in 8 patients with RBBB, 10 patients with LBBB, and 10 control subjects. All patients had angiographically normal coronary arteries and normal left ventricular function. Baseline (bAPV) and adenosine-induced hyperaemic average flow velocity and coronary flow velocity reserve (CFVR) were measured in left anterior descending arteries. Intravascular ultrasound showed no difference in lumen cross-sectional area and plaque burden between groups. Patients with RBBB and LBBB had higher bAPV values than controls (19.0±4.9, 21.9±5.1, and 14.6±2.4 cm/s, respectively; ANOVA P=0.003). There was no difference between patients with LBBB and RBBB compared with controls in CFVR (2.8±0.5, 3.0±1.0, and 3.4±0.7, respectively; ANOVA P=0.21).

Conclusion Bundle branch blocks, in particular LBBB, are associated with an increased coronary flow velocity, which indicates enhanced myocardial oxygen demand on the basis of mechanoenergetic disturbance. This may contribute to the unfavourable outcome of patients with intraventricular conduction delay.

Key Words: Coronary flow, Doppler, Right bundle branch block, Left bundle branch block

* Corresponding author. Tel: +49 201 723 4404; fax: +49 201 723 5837. E-mail address: heinrich.wieneke{at}uni-essen.de


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