Key result
Patients meeting strict LBBB ECG criteria (Strauss) had a higher response rate to cardiac resynchronization therapy at 6 months compared to other LBBB morphologies (85.7% vs 33.3%; p=0.023).
Why the study?
To assess ventricular myocardium activation patterns by non-invasive epi- and endocardial mapping and ECG variants of LBBB, estimating their value for CRT success.
Do strict LBBB ECG criteria and non-invasive mapping of ventricular electrical uncoupling predict echocardiographic response to CRT in patients with heart failure?
Observational (n=28)
Do strict LBBB ECG criteria and non-invasive mapping of ventricular electrical uncoupling predict echocardiographic response to CRT in patients with heart failure?
Strict LBBB criteria and non-invasive mapping of ventricular electrical uncoupling can help identify patients most likely to respond to cardiac resynchronization therapy.
PURPOSE: To assess and to compare the ventricular myocardium activation patern obtained by non-invasive epi- and endocardial mapping (NIEEM), as well as electrocardiographic (ECG) variants of lef bundle branch block (LBBB) and to estimate the value of these data for the success of cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: Te study included 23 patients (mean age 59,6±9,9 years) with LBBB, QRS duration ≥ 130 ms, lef ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of LBBB ECG-criteria, proposed by Strauss D.G. et. al, patients were divided into 2 groups: 1group - strict LBBB, proposed by Strauss D.G. et. al. (n=14) and 2 group - other ECG morphologies of LBBB (n=9). NIEEM by the Amycard 01C system with an analysis of epi- and endocardial ventricular electrical activation was performed in all patients and 5 healthy volunteers (mean age 29±1,0years). Response to CRT was estimated by echo and was defned as decrease in lef ventricular (LV) end-systolic volume by > 15% afer 6 months of follow-up. RESULTS: LBBB ECG-criteria, proposed by Strauss D.G. et. al, was detected in 14 patients (61% of all included). According to the results of NIEEM, these patients had more pronounced ventricular electrical uncoupling (VEU) (р=0,002). Most ofen the line of block was detected in the anteroseptal or posterolateral region of the LV. Te zone of late LV activation, which is the most optimal position for the LV pacing electrode, was located in the basal and middle segments of the lateral and posterior walls. Afer 6 months of CRT 15 patients (65%) were included in the "response" group, the remaining 8 patients (35%) formed the "non-response" group according to echo criteria. In the "response" group the morphology of the QRS complex more frequently met the criteria, proposed by Strauss D.G. et al, than other ECG variants of LBBB (12 vs. 3 respectively, p = 0.023). Initially, VEU was more pronounced in the "response" group (VEU 55 [51, 64] ms in the "response" group vs 22 [8, 38] ms in the "non-response" group).Сonclusions. LBBB ECG criteria, proposed by Strauss D.G., identify patients with delayed transseptal interventricular conduction due to complete LBBB, what is a good target for CPT. Identifcation of individual ventricular activation properties may help to reveal responders to CRT in patients with LBBB.
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Kashtanova et al. (2019) conducted an observational in Left bundle branch block and heart failure (n=28). Strict LBBB (Strauss criteria) vs. Other ECG morphologies of LBBB was evaluated on Response to CRT (decrease in LV end-systolic volume by > 15% after 6 months) (p=0.023). Patients meeting strict LBBB ECG criteria (Strauss) had a higher response rate to cardiac resynchronization therapy at 6 months compared to other LBBB morphologies (85.7% vs 33.3%; p=0.023).
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