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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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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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[Association of left bundle branch block definitions with response to cardiac resynchronisation therapy in patients

V A Kuznetsov1, L M Malishevskii1, V V Todosiychuk1

  • 1Tomsk National Research Medical Center of the Russian Academy of Sciences, Tyumen Cardiology Research Center, Tomsk, Russia.

Kardiologiia
|November 6, 2020
PubMed

Insights

Different criteria for complete left bundle branch block (cLBBB) impact prediction of reverse left ventricular remodeling after cardiac resynchronization therapy (CRT). Strauss criteria showed highest sensitivity, while AHA and RAFT criteria offered the best specificity for predicting CRT response.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Complete left bundle branch block (cLBBB) is a key indicator for cardiac resynchronization therapy (CRT).
  • Predicting reverse left ventricular (LV) remodeling post-CRT is crucial for patient outcomes.
  • Various diagnostic criteria exist for identifying cLBBB, potentially impacting treatment prediction.

Purpose of the Study:

  • To compare the diagnostic significance of different cLBBB criteria in predicting reverse LV remodeling.
  • To evaluate the effectiveness of various cLBBB criteria in identifying patients who will benefit from CRT.

Main Methods:

  • Ninety-three patients undergoing CRT were analyzed.
  • Left ventricular end-systolic volume (LV ESV) changes determined CRT response (responders vs. non-responders).
  • Nine different criteria for cLBBB diagnosis were assessed, including those from major clinical guidelines (AHA, ESC) and large multicenter studies (MADIT-CRT, REVERSE, RAFT).

Main Results:

  • Incidence of cLBBB was significantly higher in CRT responders across multiple criteria (AHA, ESC 2013, Strauss, MADIT-CRT, REVERSE, RAFT).
  • The Strauss criterion demonstrated the highest sensitivity (80.3%) and overall accuracy (72.04%).
  • AHA and RAFT criteria exhibited the highest specificity (92.6%). Clinical guideline criteria (AHA, ESC 2013) showed strong consistency (κ=0.818).

Conclusions:

  • The diagnostic criteria used for cLBBB influence the prediction of reverse LV remodeling following CRT.
  • While guideline criteria (AHA, ESC 2013) and Strauss criteria are effective, they vary in sensitivity and specificity.
  • Inconsistencies in cLBBB criteria used in large multicenter studies necessitate careful interpretation of their findings.

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