Left bundle branch block without a typical contraction pattern is associated with increased risk of ventricular arrhythmias in cardiac resynchronization therapy patients.

Autor: Bouazzi S; Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark. shema.bouazzi@regionh.dk., Tayal B; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Hansen TF; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark., Vinther M; Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark., Kisslo J; Division of Cardiovascular Medicine, Duke University Medical Center, Durham, USA., Gorcsan J 3rd; Division of Cardiology, Washington University in St. Louis, St. Louis, USA., Svendsen JH; Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Søgaard P; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Saba S; Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, USA., Risum N; Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark.
Jazyk: angličtina
Zdroj: The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2021 Jun; Vol. 37 (6), pp. 1843-1851. Date of Electronic Publication: 2021 Mar 23.
DOI: 10.1007/s10554-021-02157-8
Abstrakt: Cardiac resynchronization therapy (CRT) reduces the risk of ventricular arrhythmias (VA) in heart failure (HF) patients with left bundle branch block (LBBB) while the effect is less clear among non-LBBB patients. This study aimed to investigate if absence of LBBB features whether by echocardiography or strict ECG criteria would identify patients at risk of developing VA in a cohort with LBBB according to conventional ECG criteria. Two hundred six CRT candidates were prospectively included from 2 centers. Prior to CRT presence of a typical LBBB contraction pattern was identified using longitudinal strain in the apical 4-chamber view. All preimplantation ECGs were categorized as LBBB or non-LBBB according to Strauss´ strict criteria. Primary end-point was defined as any appropriate antitachycardia pacing (ATP) or shock therapy within 2 years after CRT implantation. A total of 129 (63%) patients had a typical LBBB contraction pattern, while 134 (66%) met the strict ECG criteria. Over 2 years, 45 patients (22%) experienced VA. Absence of a typical LBBB contraction pattern was independently associated with an increased risk of VA (hazard ratio ([HR] 1.89; 95% CI 1.04 to 3.44; p: 0.036). Strict LBBB was not independently associated with the occurrence of VA. Fulfilling neither strict ECG nor echocardiographic criteria for LBBB was associated with a 3.3-fold increase in risk of VA ([HR] 3.34; 95% CI 1.75 to 6.94; (p < 0.001). The risk of VA was almost 2-fold higher if a typical LBBB contraction pattern was absent prior to CRT.
Databáze: MEDLINE
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