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Sports_LBBB_Overview.html
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Sports_LBBB_Overview.html
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<!DOCTYPE html>
<html lang="en">
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<meta name="viewport" content="width=device-width, initial-scale=1" />
<head>
<meta charset="UTF-8">
<title>CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Left Bundle Branch Block</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
-webkit-margin-before:0;
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</head>
<body>
<div class="topbar">
<a href="index.html">Pedi CardioRef</a>
<div class="guidelinebar">
<a target="_blank" rel="noopener noreferrer" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000245">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 9: Arrhythmias and Conduction Defects</a>
</div>
</div>
<section style="margin:10px">
<p class="topspace"></p>
<label><b>By the ACC/AHA 2015 guidelines, should my patient with</label>
<select name="disease" id="dz" class="InputBox" onChange="goThere();">
<option value="">*Select Disease*</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HCM">Hypertrophic Cardiomyopathy </option>
<option value="LVNC">Left Ventricular Non-Compaction </option>
<option value="DilRestr">Dilated or Restrictive Cardiomyopathy </option>
<option value="ARVC">Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) </option>
<option value="Myo">Myocarditis </option>
<option value="Peri">Pericarditis </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="ASDVSDPDA">ASD, VSD, or PDA </option>
<option value="PS">Pulmonic Stenosis </option>
<option value="AS">Aortic Stenosis </option>
<option value="Coarct">Coarctation </option>
<option value="Cyan">Cyanotic Heart Disease, unrepaired or with palliative shunt </option>
<option value="TOF">Tetralogy of Fallot, s/p repair </option>
<option value="TGA_Must">d-transposition (d-TGA), s/p atrial switch (Mustard/Senning)</option>
<option value="TGA_Art">d-transposition (d-TGA), s/p arterial switch </option>
<option value="CCTGA">Congenitally-corrected TGA (CC-TGA, L-TGA)</option>
<option value="Fontan">Fontan </option>
<option value="Ebstein">Ebstein Anomaly </option>
<option value="AnomCoronary">Anomalous Coronary Artery Origin</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="PVR">Elevated PVR in CHD </option>
<option value="VentricularDysfxn">Ventricular Dysfunction s/p CHD Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Valve_AS">Aortic Stenosis</option>
<option value="Valve_AR">Aortic Regurgitation </option>
<option value="Valve_MS">Mitral Stenosis</option>
<option value="Valve_MR">Mitral Regurgitation </option>
<option value="Valve_Hx">History of Mitral or Aortic Valve Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HTN">Hypertension </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="AoDiseases_and_Marfan">Aortic Diseases and Marfan Syndrome</option>
<option value="BAV">Bicuspid Aortic Valve</option>
<option value="Marfan">Marfan Syndrome</option>
<option value="TAA">Thoracic Aortic Aneurysm, familial or unexplained</option>
<option value="LoeysDietz_EhlersDanlos">Loeys-Dietz or vascular Ehlers-Danlos</option>
<option value="AoEnlarge">Enlarged Aorta, non-syndrome non-familial</option>
<option value="Ao_Surgery">S/p Surgery for Aortic Enlargement/Dissection</option>
<option value="Chronic_AoDissection">Chronic Aortic Dissection or Branch Aneurysm</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="CoronaryOverview">Coronary Artery Disease </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Syncope">Syncope </option>
<option value="Arrhythmia">Arrhythmias (SVT, PVC, Vtach, etc.) </option>
<option value="ConductionDefect">Conduction Defects (AV block, brady, pacemaker, RBBB/LBBB)</option>
<option value="Channelopathies">Channelopathies (LQTS, CPVT, Brugada, etc.) </option>
<option value="ICD">Implantable Cardioverter-Defibrillator (ICD) </option>
</select>
<span>participate in organized sports?</span></b>
<br><br>
<section id="question">
Should my patient with <b>Complete Left Bundle Branch Block</b> participate in organized sports?
</section>
</section>
<!-- End of 10px margin section. Consider changing template. -->
<br>
<!-- navigation bar for disease sub-categories -->
<nav>
<a href="Sports_Pacemaker_Overview.html">Permanent pacemaker</a>
<a href="Sports_SinusBrady_Overview.html">Sinus bradycardia</a>
<a href="Sports_AVB_1_Overview.html">1st-degree AV block</a>
<a href="Sports_AVB_2_Type1_Overview.html">2nd-degree AV block, Type 1 (Wenckebach)</a>
<a href="Sports_AVB_2_Type2_Overview.html">2nd-degree AV block, Type 2</a>
<a href="Sports_AVB_complete_congen_Overview.html">Congenital high-grade or complete AV block</a>
<a href="Sports_AVB_complete_acquired_Overview.html">Acquired complete AV block</a>
<a href="Sports_RBBB_Overview.html">Complete RBBB</a>
<a href="Sports_LBBB_Overview.html" class="active">Complete LBBB</a>
</nav>
<div class="largeanswerbox">
<h2 align=center>Complete Left Bundle Branch Block</h2>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Symptomatic?</li>
<li>Structrual heart disease?</li>
<li>+/- EP study (if symptomatic)</li>
</ul>
</section>
<section id="answer_arrow_section">
<section class="third_invisible">⇙</section>
<section class="third_invisible">⇓</section>
<section class="third_invisible">⇘</section>
</section>
<section id="answer">
<section class="third_left">
<p class="sectiontitle">Asymptomatic, no spontaneous type II second-degree AV block or complete heart block</p>
<p>"Athletes with permanent or rate-dependent LBBB who do not develop spontaneous type II second-degree AV block (Mobitz)
or complete heart block and who have no symptoms or heart disease identified by appropriate testing that
otherwise precludes participation, can participate in all competitive athletics."
</p>
<div class="verdict_ok"><b>All sports = reasonable</b> if conditions met and no other heart disease that would preclude participation</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="third_middle">
<p class="sectiontitle">Symptoms</p>
<p>"In athletes with concerning symptoms, an EPS is recommended.
An athlete with a normal HV interval and a normal AV conduction response to pacing can
participate in all competitive sports unless otherwise restricted by their structural heart disease."
</p>
<div class="verdict_maybe"><b>If EP study shows normal HV interval and normal AV conduction response to pacing,
then all sports are acceptable</b> (unless restricted by other heart disease)</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="third_right">
<p class="sectiontitle">Abnormal AV conduction (HV interval >90 ms or His-Purkinje block)</p>
<p>"Athletes with abnormal AV conduction characterized by an HV interval >90 ms or a His-Purkinje block
should have pacemaker implantation."
</p>
<div class="verdict_no"><b>Should have pacemaker</b></div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
</section>
</div>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000245"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects.</a>
A Scientific Statement From the AHA and ACC. Circulation 2015</i>
<br><br><b>Disclaimer:</b> This website is derived from published guidelines, but does not constitute medical advice nor does it replace clinical judgement. Only the text in quotation marks are direct quotations from the original guidelines. Text not in quotations as well as the method of information display are all that of the website creator and are not part of the original published guidelines. Please consult a physician to discuss any patient-specific matters.
</p>
<section class="key">
<p><b>Key:</b> EPS = Electrophysiology study, LBBB = left bundle branch block
</p>
</section>
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