Pediatric Left Bundle Branch Block Treatment & Management

Updated: May 25, 2018
  • Author: Bahram Kakavand, MD, FACC, FHRS, CEPS-PC; Chief Editor: Stuart Berger, MD  more...
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Treatment

Approach Considerations

Children with left bundle branch block (LBBB) should be referred to a pediatric cardiologist for careful and complete evaluation.

Medical care

Patients with LBBB require complete cardiac evaluation, and those with LBBB and near-syncope, syncope or heart failure may require a pacemaker. Guidelines for evaluating and managing patients with syncope, [15]  those for heart failure, [16, 17, 18]  and those for device-based therapy of cardiac rhythm abnormalities [19, 20]  have been established and continue to be revised by the American College of Cardiology and American Heart Association.

Continuous telemetry may be considered if the LBBB might be associated with other arrhythmias (see Imaging Studies).

Progression from left anterior hemiblock (LAH) to high degrees of block is unusual, and patients require only observation.

Surgical care

Patients with congestive heart failure and intrinsic LBBB or LBBB due to chronic right ventricular pacing may benefit from cardiac resynchronization therapy (CRT); however, the improvement in clinical or echocardiographic parameters varies and is, at times, unpredictable. [21, 22]

Outpatient care

LBBB may rarely progress to complete heart block and sudden death. In these patients, prognosis depends on the associated cardiac disease more than the LBBB itself. Yearly evaluation, including electrocardiography (ECG), is recommended, with follow-up more frequent than this if indicated by underlying cardiac disease and changes in patient's clinical course and symptoms.

Patients with LBBB, left axis deviation, and first-degree heart block or LBBB and near-syncope or complete syncope require close follow-up care. They should be referred for consultation with an electrophysiologist and possibly pacemaker insertion.

Patients with LBBB need evaluation at regular intervals for possible left ventricular dysfunction. This may happen years after the onset of LBBB.

For patient education resources, see the Heart Health Center.

Activity

Activity restrictions primarily depend on the underlying cardiac cause of the LBBB pattern and on whether the patient develops important arrhythmias (bradycardia, tachycardia) during prolonged exertion.