LBBB in Older Male Athlete - What to expect

Hi all!  I'm new to this forum.  A little background.  I'm 67 year old male, in excellent physical shape - dont smoke, have 117/70 BP, have resting HR 45-50, 6'3" tall, 188lbs, 10% body fat, exercise 2-3 hours daily with some sort of activity from rock and ice climbing, running, road biking, alpine mountaineering, weight lifting, etc.

Several years ago I was experiencing a significant number of PVCs.  My doctor at the time was a cardiologist also.  He had me do a EKG treadmill stress test.  At about 80% of my max, my heart exhibit LBBB symptoms.  Last month I was in the ER for a completely different issue.  While in a resting state, they did an EKG and were quite alarmed at the LBBB indication.  Echocardiogram, cardioCT scan, blood tests, chest x-ray all showed no problems except for the conduction issues messing up the echocardiogram measurements.  EF was measured at 50% while resting.

What I read about LBBB has me deeply worried.  Words like "heart failure" and all sorts of other nasty stuff.  About 3 years ago I had a major accident ice climbing and ended up with some titanium and stainless steel in my body to stich me back together.  Ever since then, I get completely winded with the slightest level of exercise.  3 years ago it was no problem to do 8:30min/mile mile after mile.  Now I can barely get to a 13min/mile pace for a few miles.  I get completely out of breath doing the simplest activities.  On top of that, after reading about all the bad stuff LBBB can do to a heart, I've backed way off even considering doing serious high altitude mountaineering.

I'm going in for a nuclear stress test to rule out CAD, which I have no history in me or my family so I'm going to forecast that the relaxed state and exercise state will both show LBBB but no blood starvation to the heart.

So, here's the question - will the Docs look at me and say "Hey your generally healthy, just deal with doing less (a whole lot less)"?  Or will they consider a RR CRT pacemaker, which I would be fine with if I properly understand what they do.

Thanks for any thoughts or experiences you want to share as I figure out how to navigate this



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!



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

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