P3801The impact of the type of response to cardiac resynchronization therapy in the survival of patients with advanced heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Camanho ◽  
C Slater ◽  
L A Oliveira Jr ◽  
L Carvalho Dias ◽  
E B Saad ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Total Mortality ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Implant Survival ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Group I ◽  
Qrs Duration ◽  
The Mean

Abstract Fundamental Cardiac resynchronization therapy (CRT) reduces total mortality in patients (pt) with advanced heart failure (HF). However, the impact of this reduction is unknown in the different types of response. Objective To describe the survival of responders and super responders pt to CRT in a retrospective cohort. Methods 250 pt who underwent a CRT were retrospectively evaluated. All presented in functional class (FC) III/ IV (NYHA). The criteria of response to CRT were: improvement of FC (>1); increase in ejection fraction (EF) >10% and decrease in left ventricular end-systolic diameter (LVESD) – >15%. They were divided into three groups: Group I – 73/250 pt (33%): responder only by the criterion of FC improvement. Group II - 57/250 pt (24%): responder was defined by three criteria (clinical and echocardiographic). Grupo III - super responder – 48/250 pt (20%): decrease >30% in LVESD and/or EF >45%. The survival and clinical outcomes were analyzed in the 3 groups. Results In group I, the mean age was 68.7 years; 75% were male; left bundle branch block (LBBB) was observed in 93% and average QRS duration was 164 ms; EF: 26%; average LVESD and left ventricular end-diastolic diameter (LVEDD): 46 and 57.7 mm, respectively. BIV-ICD was observed in 72% of pt. The mean post-implant survival was 30.8 months (CI95%: 25.06–36.54). In group II, the mean age was 70 years; 82% were male; left bundle branch block (LBBB) was observed in 98% and average QRS duration was 166 ms; EF: 27.5%; average LVESD and LVEDD: 52 and 67 mm, respectively. BIV-ICD was observed in 75% of pt. The mean post-implant survival was 45.4 months (CI95%: 38.96–51.84). In group III, the mean age was 71 years; 65% were male; left bundle branch block (LBBB) was observed in all pt (100%) and average QRS duration was 176 ms; EF: 29.2%; average LVESD and LVEDD: 54 and 68 mm, respectively. BIV-ICD was observed in 70% of pt. The mean post-implant survival was 53 months (CI95%: 45.96–60.04). The total mortality observed was 11%, 17% and 6.25%, respectively (48%: neoplasia; 24%: stroke; 19%: terminal HF; 9%: sepsis). Conclusion In the present study, the survival of responders pt to CRT varied according to the type of response, being significantly higher in the super responders and in those who presented echocardiographic criteria of response to CRT. These findings present significant clinical relevance and should be evaluated in future studies.

scholarly journals Relationship between left bundle branch block patterns and super-response to cardiac resynchronization therapy in patients with heart failure

2021 ◽  
Vol 26 (7) ◽  
pp. 4227
Author(s):  
N. E. Shirokov ◽  
V. A. Kuznetsov ◽  
V. V. Todosiychuk ◽  
A. M. Soldatova ◽  
D. V. Krinochkin
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Septal Wall ◽  
Group I

Aim. To assess a relationship of left bundle branch block (LBBB) patterns defined by electrocardiography (ECG) and echocardiography with super-response (SR) to cardiac resynchronization therapy (CRT).Material and methods. Sixty patients (mean age, 54,5±10,4 years) were examined at baseline and during follow-up (10,6±3,6 months). Patients were divided into groups: group I (n=31) — decrease of left ventricular end-systolic volume (ESV) ≥30% (super-responders) and II group (n=29) — decrease of LV ESV <30% (non-super-responders). Three strain-markers of LBBB assessed by tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) were used: early contraction of basal or midventricular segment in the septal wall and early stretching of basal or midventricular segment in the lateral wall (marker 1); early peak contraction of the septal wall occurred in the first 70% of the systolic ejection phase (marker 2, septal flash (SF)); early stretching wall that showed peak contraction after aortic valve closure (marker 3). The classical LBBB pattern was defined if all three strain-markers were present. The heterogeneous LBBB pattern was defined if two from three strain-markers were present.Results. At baseline, groups did not differ in main clinical characteristics, including QRS width and LBBB assessed by ECG. Mechanical abnormalities were found only in group I: SF (32,3% vs 0,0%; p=0,001) and apical rocking (19,4% vs 0,0%; p=0,024), as well as classic LBBB mechanical pattern (20,8% vs 0,0%; p=0,05). The complex of heterogeneous LBBB mechanical pattern (odds ratio (OR), 7,512; 95% CI, 1,434-39,632; р=0,025), interventricular mechanical delay (OR, 1,037; 95% CI, 1,005-1,071; р=0,017) and longitudinal strain of interventricular septum mid segment (OR, 0,726; 95% CI, 0,540-0,977; р=0,035) had an independent relationship with SR. According to the ROC analysis, the sensitivity and specificity of model in SR prediction were 77,3% and 91,3% (AUC=0,862; p<0,001).Conclusion. SR is associated with both LBBB mechanical patterns assessed by STE and TDI. LBBB defined by ECG did not have significant association with SR to CRT.

P1242ECG predictors of outcome in non-left bundle branch block cardiac resynchronization therapy patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A M W Van Stipdonk ◽  
M Dural ◽  
F Salden ◽  
I A H Ter Horst ◽  
H J G M Crijns ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Primary Endpoint ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Qrs Morphology ◽  
Qrs Duration

Abstract Background The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients. Purpose To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients. Methods Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (≥/<150ms), QRS area (≥/<109μVs), left ventricular activation time ((≥/<125ms), and the presence of fragmented QRS (fQRS). The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated. Results There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area ≥109 μVs (p<0.001) and in those without fQRS present (p=0.004) (figure 1). Figure 1 Conclusion A large QRS area and the absence of fQRS are positively associated to event free survival in non-LBBB patients treated with CRT. Whereas currently used patient selection cut-off QRS duration is not associated to outcome in these patients. These data may provide additional value for the non-LBBB patient selection for CRT and warrant prospective evaluation of these ECG features. Acknowledgement/Funding None

Abstract P64: Right Ventricular Outflow Septal Pacing as Cardiac Resynchronization Therapy in Patients with Right Bundle-Branch Block: Results in 62 Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Phillip E Schrumpf ◽  
Michael Giudici ◽  
Deborah Paul ◽  
Roselyn Krupa ◽  
Cynthia Meirbachtol
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Ventricular Performance ◽  
Bundle Branch Block ◽  
Qrs Duration

Background: Cardiac resynchronization therapy has been shown to improve left ventricular performance in patients with left ventricular dysfunction and a left-sided interventricular conduction delay. This is performed by placing a pacing lead on the lateral left ventricular wall to stimulate the area normally stimulated by the left bundle branch. In patients with right bundle branch block (RBBB), pacing the right bundle branch could also result in resynchronization. Previous studies have shown that right ventricular outflow septal (RVOS) pacing does, in fact, utilize the native conduction system. Methods: 62 consecutive patients, 46 male/16 female, aged 75 +/− 10.5 yr, with RBBB and indications for pacing, underwent RVOS lead placement using commercially available pacing systems. The patients subsequently underwent bedside A-V optimization to achieve the narrowest QRS duration and most “normal” QRS complex. Echocardiography was performed to evaluate changes in wall motion comparing baseline with optimal pacing. Results: Baseline mean QRS duration 146 +/− 20.9 ms Optimized mean QRS duration 111 +/− 20.5 ms Average decrease in QRS duration -35 +/− 21.5 ms p < 0.001 Echocardiography demonstrated improvement in septal contraction abnormalities. Conclusions: 1) RVOS pacing in RBBB patients can significantly narrow the QRS complex on ECG. 2) Septal contraction abnormalities due to RBBB can be improved with RVOS pacing and optimal A-V timing. 3) Further studies are warranted to evaluate this therapy in a heart failure population.

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