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Proportion of candidates for cardiac resynchronization therapy
Ali Erdogan1, Sebastian Rueckleben, Harald H Tillmanns
1Department of Cardiology/Angiology, Justus-Liebig University of Giessen, Giessen, Germany. a.erdogan@web.de
Pacing and Clinical Electrophysiology : PACE
|April 12, 2003
Summary
Biventricular pacing is a heart failure therapy for patients with left bundle branch block (LBBB) and low ejection fraction. This study estimates that 5-10 such patients per 100,000 residents annually may benefit.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Biventricular pacing is an adjunct therapy for heart failure in symptomatic patients with left bundle branch block (LBBB).
- Estimates of patient numbers appropriate for this therapy are clinically and socioeconomically significant.
- Left bundle branch block (LBBB) and reduced ejection fraction are key indicators for potential biventricular pacing candidacy.
Purpose of the Study:
- To estimate the prevalence of left bundle branch block (LBBB) combined with a low ejection fraction in patients undergoing cardiac catheterization.
- To determine the number of patients who could be candidates for biventricular pacing as an adjunct therapy for heart failure.
- To identify patient characteristics associated with LBBB and low ejection fraction.
Main Methods:
- Retrospective analysis of 7,121 consecutive patients referred for elective diagnostic angiography (1996-2000).
- Identification of patients with left bundle branch block (LBBB) and ejection fraction < 0.35.
- Evaluation of comorbidities including normal sinus rhythm, mitral regurgitation, age, and coronary artery disease.
Main Results:
- Left bundle branch block (LBBB) was present in 4% of patients, with lower ejection fractions compared to those without LBBB (P < 0.0001).
- LBBB combined with low ejection fraction (< 0.35) was found in 1.4% of patients (approx. 15 per 100,000 residents/year).
- Specific criteria (LBBB, low EF, sinus rhythm, age < 75) identified 1% of patients (approx. 11 per 100,000 residents/year).
Conclusions:
- The prevalence of LBBB with severely impaired left ventricular ejection function is estimated at 1-2% in cardiac catheterization patients.
- Biventricular pacing may be considered for 5-10 patients per 100,000 residents annually in industrialized nations.
- Approximately half of these patients may also be candidates for cardioverter-defibrillators combined with permanent pacing.