Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Hadjis, Alexios; AlTurki, Ahmed; Proietti, Riccardo; Montemezzo, Mauricio; Bernier, Martin; Joza, Jacqueline; Hadjis, Tomy; Essebag, Vidal

doi:10.1111/pace.13638

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Among 205 CRT responders, 85 of 131 (65%) had strict LBBB and 120 of 204 (59%) had traditional LBBB ( P = .267). However, the duration of follow‐up was relatively short (12 months), which may lead to the difference compared with others …”

Section: Discussionmentioning

confidence: 91%

“…The Strauss criteria (notches in two leads of V1, V2, V5, V6, I, and aVL) represent the activation of the epicardial posterolateral wall and the endocardial left ventricular septum, which is special for CRT efficiency. Recently, in 231 HF patients who received CRT, typical LBBB according to the Strauss criteria predicted a reduction in QRSd and an increase in LVEF compared with conventional LBBB and non‐LBBB morphology during a mean follow‐up of 44 ± 10 months . However, with the largest population ever reported (335 patients with LBBB), Bertaglia et al found that stricter definition of LBBB did not improve response to CRT in comparison to the current AHA definition.…”

Section: Discussionmentioning

confidence: 99%

“…The notches in typical LBBB were hypothesized to result from activation of the epicardial posterolateral wall and the endocardial LV septum, where CRT would theoretically be useful. Furthermore, Hadjis et al elucidated the benefit of using Strauss criteria for CRT response. In their study, patients with typical LBBB by Strauss criteria had a significant reduction in QRSd compared with conventional LBBB and non‐LBBB patients.…”

Section: Introductionmentioning

confidence: 99%

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Typical BBB morphology and implantation depth of 3830 electrode predict QRS correction by left bundle branch area pacing

Jiang

Qin

et al. 2019

Pacing Clinical Electrophis

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Aim: Strict criteria of typical left bundle branch block (LBBB) can help with the prediction for cardiac resynchronization therapy response. The aim of this study is to determine whether the use of strict criteria for both LBBB and right bundle branch block (RBBB) predicts successful QRS correction (≤130 ms) by left bundle branch area pacing (LBBAP).Methods: Consecutive patients with pacemaker indications according to the present guideline who also underwent LBBAP implantation were retrospectively assessed. Inclusion criteria were patients with BBB and the baseline QRSd > 130 ms. Baseline characteristics and pacing parameters were compared between typical and atypical BBB groups. Multivariate logistic regression was used to adjust for covariates that were found in univariate analyses for successful QRS correction by LBBAP.Results: Seventy-three patients were enrolled. Among them, 10 (13.6%) had atypical BBB (5 LBBB and 5 RBBB) and 63 (86.4%) had typical BBB (30 LBBB and 33 RBBB). The rate of successful QRS correction was higher in typical-BBB patients (52/63; 82.5%) than that in atypical-BBB patients (3/10; 30%), P < .001. Paced QRSd was obviously narrower in patients with typical BBB than that in patients with atypical-BBB (118 ± 14 vs 133 ± 14 ms, P = .003). In multivariate logistic regression, only typical BBB morphology and the implantation depth of 3830 pacing electrode in the ventricular septum were independent predictors for successful QRS correction. Conclusion:This study demonstrates that patients with typical-BBB morphology benefit more from LBBAP for QRS correction. Typical BBB morphology together with deep penetration of 3830 ventricular electrode in the interventricular septum predicts the success of QRS correction by LBBAP. K E Y W O R D SLBBB, left bundle area pacing, morphology, QRS correction, RBBB, typical

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Typical BBB morphology and implantation depth of 3830 electrode predict QRS correction by left bundle branch area pacing

Jiang

Qin

et al. 2019

Pacing Clinical Electrophis

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“…5 Therefore, using the electrocardiogram (ECG) would be an inexpensive and practical process for CRT optimization. 4 Narrowing of the QRS complex with biventricular pacing (the paced QRS duration [QRSd]) has been shown to correlate with clinical and echocardiographic improvement, 6,7 as well as long-term mortality. 8 One study has also reported that ECG-based optimization using the measurement of the narrowest QRS is comparable to echocardiography-based optimization with regard to left ventricle (LV) reverse remodeling.…”

mentioning

confidence: 99%

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

et al. 2020

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Background: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that allows fusion of intrinsic conduction with biventricular pacing. We aimed to assess whether reprogramming chronically implanted CRT devices with SyncAV is associated with improved echocardiographic parameters. Methods: Patients at a quaternary center with previously implanted CRT devices with a programmable SyncAV algorithm underwent routine electrocardiography-based SyncAV optimization during regular CJC Open 2 (2020) 62e70

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“…QRS prolongation causes poor cardiovascular outcomes [ 2 , 4 – 7 ]. In the left bundle branch block (LBBB), a mortality increase is prominent, but cardiac resynchronization therapy is effective by shortening the QRSd [ 8 , 9 ]. QRS prolongation is a poor prognostic marker in patients undergoing coronary artery bypass surgery (CABG), as in other cardiovascular diseases [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prolonged QRS independently predicts long-term all-cause mortality in patients with narrow QRS complex undergoing coronary artery bypass grafting surgery (9-year follow-up results)

Çetın¹,

Özyıldız²,

Özer³

et al. 2020

kitp

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Aim: We investigated the association of intermediate QRS prolongation with the long-term all-cause mortality in coronary artery bypass grafting (CABG) surgery patients with a narrow QRS complex in the preoperative electrocardiography (ECG). Material and methods: A total of 221 consecutive patients with narrow QRS (< 120 ms) sinus rhythm who underwent CABG surgery were included in the study. The patients were followed up for 9.2 years postoperatively in terms of mortality outcomes. Results: Follow-up data were obtained from 211 (173 men, 38 women) of 221 patients. Death occurred in 57 of them. We examined patients in the two groups according to survival outcomes. In multivariate COX regression analysis EuroSCORE (OR = 1.342, 95% CI: 1.167-1.544, p < 0.001), extent of coronary artery disease (OR = 1.768, 95% CI: 1.034-3.020, p = 0.037), QRS duration (OR = 1.029, 95% CI: 1.002-1.058, p = 0.035) and fasting glucose levels (OR = 0.992, 95% CI: 0.984-0.999, p = 0.029) were independent predictors of all-cause mortality. QRS duration > 89.5 ms determined all-cause mortality with a sensitivity of 73.7% and a specificity of 52% (OR = 2.07) due to ROC analysis. All-cause mortality was significantly higher in patients with preop QRS duration > 90 ms from the first year (c 2 = 6.724, p = 0.010). Conclusions: In CABG patients with a narrow QRS complex, preoperative intermediate prolonged QRS is an independent predictor of all-cause mortality in long-term follow-up.

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Predicting response to cardiac resynchronization therapy: Use of strict left bundle branch block criteria

Cited by 12 publications

References 21 publications

Typical BBB morphology and implantation depth of 3830 electrode predict QRS correction by left bundle branch area pacing

Typical BBB morphology and implantation depth of 3830 electrode predict QRS correction by left bundle branch area pacing

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

Prolonged QRS independently predicts long-term all-cause mortality in patients with narrow QRS complex undergoing coronary artery bypass grafting surgery (9-year follow-up results)

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