Key result
Flecainide challenge can unmask painful LBBB syndrome mimicking paroxysmal monomorphic VT.
Why the study?
Painful left bundle branch block syndrome can mimic ventricular tachycardia in patients with structural heart disease, complicating diagnosis when LBBB is intermittently inducible.
Does flecainide unmask painful left bundle branch block syndrome masquerading as ventricular tachycardia in patients with episodic wide complex tachycardia?
Case Report
Does flecainide unmask painful left bundle branch block syndrome masquerading as ventricular tachycardia in patients with episodic wide complex tachycardia?
Flecainide may be utilized to unmask intermittent painful left bundle branch block syndrome in patients where it mimics paroxysmal monomorphic ventricular tachycardia.
Alerts clinicians to consider painful LBBB syndrome in symptomatic rate-related WCT; leaves open prospective studies on prevalence and management.
Although rare, left bundle branch block (LBBB) aberrancy can result in significant symptoms, most commonly chest pain, a clinical entity which has been termed “painful LBBB syndrome1.” When intermittent (e.g., rate-related), painful LBBB can mimic paroxysmal monomorphic ventricular tachycardia (VT), particularly in patients with structural heart disease who are found to have episodic wide complex tachycardia (WCT) correlating with chest symptoms and whose LBBB is not consistently inducible with exercise.
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Limpitikul et al. (2026) conducted a case report in Painful left bundle branch block (LBBB) syndrome. Flecainide was evaluated. Flecainide can be used to unmask painful left bundle branch block syndrome that mimics paroxysmal monomorphic ventricular tachycardia in patients with structural heart disease.
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