Patients with right bundle branch block and concomitant delayed left ventricular activation respond to cardiac resynchronization therapy
Patients with right bundle branch block and concomitant delayed left ventricular activation respond to cardiac resynchronization therapy
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DOI：
10.1093/europace/eux362
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发表时间：
2018-11-01
期刊：
影响因子：
6.1
通讯作者：
Barold, S. Serge
中科院分区：
文献类型：
--
作者：
Pastore, Gianni;Morani, Giovanni;Barold, S. Serge
右束支分支传导阻滞（RBBB）通常仅表现为延迟性右心室激动。然而，一些RBBB患者会出现伴随的延迟性左心室（LV）激动。这类患者可能表现出一种特殊的心电图（ECG）模式，类似于心前区导联中的RBBB，并伴有侧肢导联中不显著的S波（非典型RBBB）。因此，我们推测，非典型RBBB的ECG模式可能能够识别一个亚组的患者可能对心脏起搏治疗（CRT）。本研究的目的是评估RBBB心电图形态对心力衰竭（HF）患者CRT反应的影响。方法和结果我们评估了66例接受CRT治疗的RBBB患者的超声心动图临床反应，并随访了近2年。根据心电图将患者分为两组：典型RBBB组31例，非典型RBBB组35例。根据左室收缩末期容积指数（ESVi）降低≥ 15%或纽约心脏协会（NYHA）分级降低≥ 1或Packer评分变异（NYHA反应，无HF相关住院事件或死亡）对应答者进行分类。与典型RBBB组相比，非典型RBBB组的LV激动时间更长（111.9 +/- 17.6 vs. 73.2 +/- 15.4 ms; P < 0.001）。在非典型和典型RBBB组中，分别有71.4%和19.4%的患者为ESVi应答者（P = 0.001）74.3%和32.3%的NYHA应答者（P = 0.002）;同样，71.4%和29.0%的患者2年Packer评分为0结论不典型RBBB患者在CRT治疗中可获得满意的疗效，且RBBB的发生率与左室延迟传导密切相关。
Aims Right bundle branch block (RBBB) typically presents with only delayed right ventricular activation. However, some patients with RBBB develop concomitant delayed left ventricular (LV) activation. Such patients may show a specific electrocardiographic (ECG) pattern resembling RBBB in the precordial leads in association with an insignificant S-wave in lateral limb leads (atypical RBBB). We therefore postulated that the ECG pattern of atypical RBBB might be able to identify a subgroup of patients likely to respond to cardiac resynchronization therapy (CRT). The purpose of this study was to assess the impact of RBBB ECG morphology on CRT response in patients with heart failure (HF).Methods and results We evaluated the echocardiographic clinical response of 66 patients with RBBB treated with CRT and followed up for almost 2 years. The patients were divided electrocardiographically into 2 groups: 31 with typical RBBB and 35 with atypical RBBB. Responders were classified in terms of reduction in LV end-systolic volume index (ESVi) >= 15% or reduction in the New York Heart Association (NYHA) Class >= 1 or Packer score variation (NYHA response with no HF-related hospitalization events or death). The atypical RBBB group presented a longer LV activation time compared with the typical RBBB group (111.9 +/- 17.6 vs. 73.2 +/- 15.4 ms; P < 0.001). In the atypical and typical RBBB groups, respectively, 71.4% and 19.4% of patients were ESVi responders (P = 0.001) 74.3% and 32.3% were NYHA responders (P = 0.002); similarly, 71.4% and 29.0% of patients exhibited a 2-year Packer score of 0 (P = 0.002).Conclusion Patients with atypical RBBB, which is a pattern highly suggestive of concomitant delayed LV conduction, may show a satisfactory response to CRT.