Cardiac resynchronization therapy in non-left bundle branch block morphologies

John Rickard, Dharam J. Kumbhani, Eiran Z. Gorodeski, Bryan Baranowski, Oussama Wazni, David O. Martin, Richard Grimm, Bruce L. Wilkoff

Research output: Contribution to journalArticle

Abstract

Introduction: In select patients with systolic heart failure, cardiac resynchronization therapy (CRT) has been shown to improve quality of life, exercise capacity, ejection fraction (EF), and survival. Little is known about the response to CRT in patients with right bundle branch block (RBBB) or non-specific intraventricular conduction delay (IVCD) compared with traditionally studied patients with left bundle branch block (LBBB). Methods: We assessed 542 consecutive patients presenting for the new implantation of a CRT device. Patients were placed into one of three groups based on the preimplantation electrocardiogram morphology: LBBB, RBBB, or IVCD. Patients with a narrow QRS or paced ventricular rhythm were excluded. The primary endpoint was long-term survival. Secondary endpoints were changes in EF, left ventricular end-diastolic and systolic diameter, mitral regurgitation, and New York Heart Association (NYHA) functional class. Results: Three hundred and thirty-five patients met inclusion criteria of which 204 had LBBB, 38 RBBB, and 93 IVCD. There were 32 deaths in the LBBB group, 10 in the RBBB, and 27 in the IVCD group over a mean follow up of 3.4 ± 1.2 years. In multivariate analysis, no mortality difference amongst the three groups was noted. Patients with LBBB had greater improvements in most echocardiographic endpoints and NYHA functional class than those with IVCD and RBBB. Conclusion: There is no difference in 3-year survival in patients undergoing CRT based on baseline native QRS morphology. Patients with RBBB and IVCD derive less reverse cardiac remodeling and symptomatic benefit from CRT compared with those with a native LBBB.

Original languageEnglish (US)
Pages (from-to)590-595
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume33
Issue number5
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Cardiac Resynchronization Therapy
Bundle-Branch Block
Patient Rights
Survival
Cardiac Resynchronization Therapy Devices
Systolic Heart Failure
Mitral Valve Insufficiency
Stroke Volume
Electrocardiography
Multivariate Analysis

Keywords

  • Cardiac resynchronization therapy
  • Electrocardiogram morphology
  • Left bundle branch block
  • Nonspecific intraventricular conduction delay
  • Right bundle branch block

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Rickard, J., Kumbhani, D. J., Gorodeski, E. Z., Baranowski, B., Wazni, O., Martin, D. O., ... Wilkoff, B. L. (2010). Cardiac resynchronization therapy in non-left bundle branch block morphologies. PACE - Pacing and Clinical Electrophysiology, 33(5), 590-595. https://doi.org/10.1111/j.1540-8159.2009.02649.x

Cardiac resynchronization therapy in non-left bundle branch block morphologies. / Rickard, John; Kumbhani, Dharam J.; Gorodeski, Eiran Z.; Baranowski, Bryan; Wazni, Oussama; Martin, David O.; Grimm, Richard; Wilkoff, Bruce L.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 33, No. 5, 2010, p. 590-595.

Research output: Contribution to journalArticle

Rickard, J, Kumbhani, DJ, Gorodeski, EZ, Baranowski, B, Wazni, O, Martin, DO, Grimm, R & Wilkoff, BL 2010, 'Cardiac resynchronization therapy in non-left bundle branch block morphologies', PACE - Pacing and Clinical Electrophysiology, vol. 33, no. 5, pp. 590-595. https://doi.org/10.1111/j.1540-8159.2009.02649.x
Rickard, John ; Kumbhani, Dharam J. ; Gorodeski, Eiran Z. ; Baranowski, Bryan ; Wazni, Oussama ; Martin, David O. ; Grimm, Richard ; Wilkoff, Bruce L. / Cardiac resynchronization therapy in non-left bundle branch block morphologies. In: PACE - Pacing and Clinical Electrophysiology. 2010 ; Vol. 33, No. 5. pp. 590-595.
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AU - Kumbhani, Dharam J.

AU - Gorodeski, Eiran Z.

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AU - Grimm, Richard

AU - Wilkoff, Bruce L.

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N2 - Introduction: In select patients with systolic heart failure, cardiac resynchronization therapy (CRT) has been shown to improve quality of life, exercise capacity, ejection fraction (EF), and survival. Little is known about the response to CRT in patients with right bundle branch block (RBBB) or non-specific intraventricular conduction delay (IVCD) compared with traditionally studied patients with left bundle branch block (LBBB). Methods: We assessed 542 consecutive patients presenting for the new implantation of a CRT device. Patients were placed into one of three groups based on the preimplantation electrocardiogram morphology: LBBB, RBBB, or IVCD. Patients with a narrow QRS or paced ventricular rhythm were excluded. The primary endpoint was long-term survival. Secondary endpoints were changes in EF, left ventricular end-diastolic and systolic diameter, mitral regurgitation, and New York Heart Association (NYHA) functional class. Results: Three hundred and thirty-five patients met inclusion criteria of which 204 had LBBB, 38 RBBB, and 93 IVCD. There were 32 deaths in the LBBB group, 10 in the RBBB, and 27 in the IVCD group over a mean follow up of 3.4 ± 1.2 years. In multivariate analysis, no mortality difference amongst the three groups was noted. Patients with LBBB had greater improvements in most echocardiographic endpoints and NYHA functional class than those with IVCD and RBBB. Conclusion: There is no difference in 3-year survival in patients undergoing CRT based on baseline native QRS morphology. Patients with RBBB and IVCD derive less reverse cardiac remodeling and symptomatic benefit from CRT compared with those with a native LBBB.

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