The development of chest pain associated with intermittent left bundle branch block (LBBB) in the absence of coronary artery disease has been described in the literature as painful left bundle branch block syndrome. The mechanism responsible for the chest pain is unknown, but the main current hypothesis is related to acute cardiac dyssynchrony. In this syndrome, the LBBB occurs when the cycle length is equal to or less than the refractory period of the left bundle, mainly during physical effort. The chest pain in the case of the painful LBBB syndrome may range from a mild discomfort to a disabling condition. This report describes the case of a patient with typical rate-dependent LBBB associated with chest pain who was referred to electrophysiologic study (EPS) without evidence of arrhythmias.
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