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Do all intra-ventricular conduction defect ECG patterns respond equally to CRT?

Avi Sabbag1, Yonatan Morag1, Roy Beinart1

  • 1The Heart Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|July 24, 2019
PubMed
Summary

Patients with atypical left bundle branch block (ALBBB) show favorable echocardiographic response and survival rates comparable to typical LBBB, suggesting they are suitable candidates for cardiac resynchronization therapy (CRT).

Keywords:
Atypical left bundle branch blockCardiac resynchronization therapyHeart failureLeft bundle branch block

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Cardiac resynchronization therapy (CRT) efficacy varies in patients with intraventricular conduction delay (IVCD).
  • Typical left bundle branch block (LBBB) patients generally respond well to CRT, unlike many with IVCD.
  • The heterogeneous nature of IVCD suggests specific QRS patterns might influence CRT response.

Purpose of the Study:

  • To investigate the echocardiographic and survival outcomes of CRT in patients stratified by QRS morphology.
  • To identify specific IVCD patterns, including atypical LBBB (ALBBB), that may predict response to CRT.
  • To compare CRT response in typical LBBB (TLBBB), ALBBB, and other IVCD (OIVCD) groups.

Main Methods:

  • Analysis of baseline ECGs from 239 patients undergoing CRT implantation.
  • Classification of patients into TLBBB (n=67), ALBBB (n=74), and OIVCD (n=98) based on QRS morphology.
  • Assessment of 2-year mortality and echocardiographic response (LVESV decrease or LVEF increase) at 1 year.

Main Results:

  • Echocardiographic response rates were 75% for TLBBB, 72% for ALBBB, and 50% for OIVCD (p=0.01).
  • Multivariable analysis indicated a lower likelihood of response in OIVCD (HR=0.40) but not in ALBBB (HR=0.98) compared to TLBBB.
  • Two-year survival rates were 86% for TLBBB, 88% for ALBBB, and 76% for OIVCD (p=0.011).

Conclusions:

  • Patients with ALBBB demonstrate favorable echocardiographic response and survival rates similar to TLBBB patients.
  • ALBBB, characterized by specific ECG criteria, represents a subgroup of IVCD that may benefit from CRT.
  • These findings support considering ALBBB patients for CRT implantation.