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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

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New strict left bundle branch block criteria reflect left ventricular activation differences

Kasper Emerek1, Niels Risum2, Søren Hjortshøj1

  • 1Department of Cardiology, Aalborg University Hospital, Hobrovej 16-18, 9000 Aalborg, Denmark.

Journal of Electrocardiology
|August 3, 2015
PubMed

Insights

Interventricular electrical delay and strict left bundle branch block (LBBB) criteria predict cardiac resynchronization therapy (CRT) success. New ECG criteria improve prediction of left ventricular remodeling in heart failure patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is a key treatment for heart failure patients with left bundle branch block (LBBB).
  • Predicting CRT response remains challenging, necessitating refined diagnostic criteria.
  • Optimizing CRT outcomes requires accurate assessment of electrical conduction delays.

Purpose of the Study:

  • To evaluate the efficacy of pacing lead electrical delays and strict LBBB criteria in predicting CRT outcomes.
  • To compare the predictive power of new strict LBBB criteria against traditional ones for CRT response.
  • To investigate the relationship between right ventricular to left ventricular electrical delay (RV-LV-IED) and left ventricular remodeling post-CRT.

Main Methods:

  • Forty-nine patients with LBBB and QRS duration >130 ms received CRT.
  • Right ventricular to left ventricular electrical delay (RV-LV-IED) was measured.
  • CRT response was defined as a ≥15% decrease in left ventricular end-systolic volume.

Main Results:

  • Patients with non-ischemic dilated cardiomyopathy (DCM) showed higher CRT response rates (90%) than those with ischemic heart disease (IHD) (62%).
  • New strict ECG criteria improved response prediction, particularly in IHD patients (95% in DCM, 78% in IHD).
  • Longer RV-LV-IED correlated with better CRT response and predicted left ventricular remodeling.

Conclusions:

  • Interventricular electrical delay is a significant predictor of left ventricular remodeling following CRT.
  • New, strict ECG criteria for LBBB offer superior prediction of remodeling compared to previous criteria.
  • These findings can help optimize patient selection for CRT and improve treatment efficacy.
Abstract

Keywords:
Cardiac resynchronization therapyHeart failureInterventricular electrical delayIschemic heart diseaseLeft bundle branch blockNon-ischemic dilated cardiomyopathy

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