LBBB in Older Male Athlete - What to expect

LBBB

by AgentX86 - 2021-01-18 21:04:18

In my opinion, as long as everything else is OK there isn't a lot to worry about.  It sounds like your cardiologist has done everything to eliminate the worst.  I'd recommend having an EP (electrophysiologist) have a look now.  Think of cardiologists as plumbers.  They're concerned with the structural components of the heart.  EPs are electricians, a sub-specialty concerned with the heart's electrial systems.  EPs are cardiologists but cardiologists aren't EPs.  EPs are a sub-specialty of cardiologist who's done another two years of residency in electrophysiology after his cardiology residency. The Left Bundle Branch is part of the electrical system so you shouldn't be relying on a cardiologist.

Don't put up with doctors telling you that you can no longer be active.  You're not that old (I'm 68 ;-).  Since you're in good shape, push them to get you back to where you want to be.  Don't let this turn you into a couch potato. You may need a pacemaker but worry about that bridge when you come to it.  It's not a big deal if/when you do.  Not being able to be as active as you want, is.

With an LVEF of 50%, it's doubtful that they'd use a CRT pacemaker.  They generally don't go to a CRT if the LVEF drops to 30-35%.  A normal LVEF is 50-65% so you're good.  And RR is only needed if you have sick sinus syndrome, or some such.  This doesn't matter either.  You'll get what you need and worry about the trivia only when it's necessary.  You'll go nuts if yo worry about every little possibility.  It'll do you no good at all (just the opposite).

I wouldn't worry too much about scary words like "heart failure" either.  Basically it means that the heart isn't pumping enough to fully meet the demands of the body.   It's certainly not good but there are many therapies to counteract heart failure.  People can live a long life with heart failure. With an LVEF of 50%, I wouldn't worry too much.

In short, be concerned but not too much.  Let things play out.  See the best doctors you can find and don't let them tell you that you need a wheelchair, just yet.  ;-)

ER experience

by Persephone - 2021-01-18 21:55:45

Good evening, Climber - I'm not sure how much addl diagnostics you've had since your ER visit, but keep in mind that an ER experience can be quite different from an office appt w a specialist. I can understand your concern about the ER staff expressing alarm regarding your test results, but they have different expertise than an EP / cardiologist.  Stay the course and let your new medical team know your needs - they are best equipped to help you get back to your activities.

Left Bundle Branch Block

by Selwyn - 2021-01-19 06:18:56

Left bundle branch block (LBBB) can be without symptoms and is unlikely to limit longevity provided there is no diagnosable  cause.  Most people don't even know that they have a LBBB  until they have an ECG, for whatever reason.  Having said that, then the delayed  electrical response to the left ventricle is likely to reduce cardiac output. This is of no consequence if you are fit and well and don't want to set a world record! 

It is worth looking for causes of LBBB. It certainly sounds that your physicians have this in hand. I would be guided by them. 

I thought the main  reason for exercise was to keep you healthy. Too much of anything is unhealthy, and that includes exercise. What I have learnt from observation is that all the older guys ( 90+) do exercise, however this is in moderation.  I did know a very fit pensioner running marathons around the world ( He used to administer our local athletics club). When I last talked to him, he had had a heart attack!

 I have had to accept that age does limit physical challenges. Sometimes the mind needs to exercise more than the body.  Meanwhile, I am still trying to take a few minutes off my time for my daily 15 mile cycle. Crazy!

LBB

by Terry - 2021-01-20 18:50:53

If you were to see an EP at Mayo, Cleveland Clinic, or a university hospital where they have moved on to His bundle pacing, yes, for CRT, you would no longer need a left heart lead. Search His-pacing on your browser for the latest.

LBBB in Older Male Athlete - What to expect -Thanks for the Responses!

by ClimberTom - 2021-02-15 17:29:07

Thanks everyone for sharing your thoughts.  I find this very helpful. (Specially your comments AgentX86!  I appreciate the encouragement)  I have since followed up with a cardiologist who heads up a team including EP, pulmonologist, and a sports cardiologists.  The nuclear stress test showed that I have not had any sort of infarction - good news.  Next did CPET, which produces a huge amount of data that I am not up to trying to interpret.  Lots of good pulmonary and cardiac numbers that put me in the elite athlete category, but also several other ones that are well below normal.  All seem to point to good pulmonary function, but poor cardiac output at high work loads.

More tests yet to come - pulmonary function test then cardiac MRI then meet with the sports cardiologists.

Thanks again everyone, will keep you posted if your interested

Latest Result From Long list of Tests

by ClimberTom - 2021-07-06 16:42:33

Wanted to update and share with everyone interested my experience over the last several months and what the current outcome is.  Since Jan 2021 I have seen 3 cardiologist specialist and one pulmonology specialist.  They were all stumped.  I have had SPECT, PET, numerous ECG, Cardiac MRI, CPT, PFT, genetic testing and finally a left and right cardiac catheritization with exercise.

It is important to note that fitness-wise I am not your average jogger.  In 2017 I did a one day summit of a 21,500ft peak in the Himalayas, and led an (unsuccessful) expedition to Annapurna IV (24,600).  So many of the tests showed amazing cardiac or pulmonary results such as Vo2Max of 41, 16L/min max heart volume, and many other off-the-chart results, yet I currently can barely hike up a hill or do better than 13min/mile run.  Some might think that for 67, this is normal, but I hang with other mid to late 60 year-olds, who are still in amazing shape.

Finally I saw a 4th cardiologist who specializes in professional athletes and advanced non-professional athletes.  He was amazing!  He had reviewed my many tests and spent 30-40 minutes just listening.  His conclusion - my LVEF of 35-40% caused by my LBBB was the root cause of my cardiomyopathy (DCM) and hypertrophic septum.  The solution - a CRT pacemaker.

Just completed my 2 weeks with a Zio-patch and next will be consultation with the EP.  

Will try to remember and write up the results after the visit with the EP

Thanks!

CRT to fix LBBB definitely a possibility

by ezrk - 2021-08-02 23:44:59

I have similar hobbies and somewhat similar issues.  Diagonosed in Oct 2020 with LBBB and heart failure,  EF of 20%  I did serious climbing in WA (Forbidden Peak, Liberty Bell/SEWS) in July and by mid-October was struggling to slowly walk a couple of miles.

The usual cardiac drug suspects (Coreg, Spironolactione and Entresto) didn't help very much until I added Bumex.  Adding a diuretic got me some reasonable fitness back and I could lowland hike reasonably well but I knew it still wasn't "right."  EF remained stuck at 20% but I was a very functional 20%...

CRT-D installed in April and within a month EF was up to 40% (per echo at four weeks).  Heart rate on a reasonably difficult local hike I do regularly (+/- 2400' and around 9 miles) went from an average heart rate of 135bpm with a peak of 170bpm down to 120bpm and peak of 150bpm 6 weeks after surgery.  I got back a week ago from climbing Eldorado Peak and Mt Baker without any issues.

So at least in my case the CRT part appears to have made a huge difference.  Notable that my blood pressure went up about 10 points in the first week after sugery.  I went from feeling slightly dizzy standing up (or especially deadlifting) to having no noticeable dizziness.

So it is definitely possible this is fixable with a CRT - I am quite convinced it has radically helped me.  I felt stronger every week after getting it and that continues (though is slowing down).