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[Relationship between prognosis and electrocardiographic characteristics in patients with left bundle branch block]
K Katayama1, S Kamakura, K Shimomura
1Department of Internal Medicine, National Cardiovascular Center.
Insights
Electrocardiographic characteristics can predict cardiac events in patients with complete left bundle branch block (CLBBB). Prolonged ventricular activation time (VAT) and QRS duration are key indicators for prognosis in CLBBB patients.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrophysiology
Background:
- Complete left bundle branch block (CLBBB) is a significant electrocardiographic finding.
- Prognostic indicators in CLBBB patients require further elucidation.
- Distinguishing between CLBBB with and without structural heart disease is crucial for risk stratification.
Purpose of the Study:
- To identify electrocardiographic (ECG) characteristics that predict prognosis in patients with CLBBB.
- To evaluate the role of body surface mapping in assessing cardiac events in CLBBB.
- To compare prognostic ECG markers in CLBBB patients with and without structural heart disease.
Main Methods:
- A cohort of 42 CLBBB patients with over 5 years of follow-up was studied.
- Patients were divided into two groups: no structural heart disease (Group A, n=18) and structural heart disease (Group B, n=24).
- 12-lead ECG and body surface mapping were performed, analyzing parameters like ventricular activation time (VAT), QRS duration, and isopotential/isointegral maps.
Main Results:
- Cardiac events occurred in 17 patients, predominantly in Group B (16 patients).
- Prolonged VAT in the middle back was significantly longer in patients who experienced cardiac events.
- Abnormalities in QRS and QRST maps, along with prolonged QRS duration, were also associated with cardiac events.
Conclusions:
- Prolongation of VAT in the middle back is a valuable index for predicting cardiac events in CLBBB.
- Abnormalities in QRS duration, QRS isopotential maps, and QRST isointegral maps are useful for cardiac event prediction in CLBBB patients.
- These ECG parameters can aid in risk stratification and management of CLBBB patients, particularly those with underlying structural heart disease.
Abstract:
The purpose of this study is to investigate the electrocardiographic characteristics that determine the prognosis in patients with CLBBB. This study included 42 patients with CLBBB who could be followed up more than 5 years. 18 patients had no structural heart disease (group A), and 24 patients had structural heart disease (group B). 12 leads ECG and body surface mapping were recorded in all patients. Cardiac event was observed in 17 patients, and 16 of them were in group B, VAT in middle back was statistically longer in cardiac event group than non cardiac event group. In group B, VAT in middle back was also statistically longer in cardiac event group. Prolongation of VAT in middle back, prolongation of QRS duration, abnormality of QRS isopotential map, and abnormality of QRST isointegral map were useful indices for predicting cardiac event in patients with CLBBB.