Primary cardiac resynchronization therapy implantation for LBBB resulted in similar 5-year cardiac event rates compared to CRT upgrades from right ventricular stimulation (53% vs 55%, P=n.s.).
Cohort (n=328)
Does upgrading to CRT from right ventricular stimulation provide similar prognostic and clinical benefits compared to primary CRT implantation for LBBB?
Upgrading to CRT from right ventricular stimulation yields similar improvements in clinical parameters and long-term prognosis compared to primary CRT implantation for LBBB.
Absolute Event Rate: 53% vs 55%
p-value: p=n.s.
INTRODUCTION: Left bundle brunch block (LBBB) and right ventricular stimulation (RVS) may be associated with asynchrony and heart failure. Differences between these two entities and their response to cardiac resynchronization therapy (CRT) are not well defined. METHODS: Patients receiving CRT from 1999 to 2006 were analyzed for cardiac events and prognosis separated between primary implants for LBBB (n = 221) and upgrades from RVS (n = 107). A subgroup of 105 patients (LBBB = 69; RVS = 36) was studied in more detail (New York Heart Association NYHA, quality of life, brain natriuretic peptide, peak VO2, left ventricular ejection fraction LVEF, wedge pressure, Cardiac Index, QRS, left-right preejection period using pulsed wave doppler, septum-lateral wall motion delay using tissue doppler imaging) at baseline and after 1 year. RESULTS: Age (68.4 +/- 11 years vs 68.7 +/- 15 years, n. s.), NYHA class (3.1 vs 3.1, n. s.), LVEF (26.4 vs 28.1, n. s.), and clinical parameters were comparable between LBBB and RVS. The latter group consisted of more patients with chronic atrial fibrillation (14% vs 37%, P = 0.03). After 1 year, NYHA class (-0.8 +/- 0.8 vs -0.6 +/- 0.8, n. s.), LVEF (+13.7 +/- 14% vs +8.7 +/- 10%, n. s.), and clinical parameters improved similarly. After a median follow-up of 2.33 +/- 1.8 years in the LBBB versus 2.43 +/- 1.9 years in the RVS group, there was no difference in long-term prognosis or cardiac events in the total cohort (5-year event rate, 53% vs 55%, P = n. s.). CONCLUSION: Upgrade patients showed similar baseline parameters and response to CRT as to primary implants. No difference in events or long-term prognosis could be observed.
Nägele et al. (Mon,) conducted a cohort in Heart failure with LBBB or right ventricular stimulation (n=328). Primary CRT implantation for LBBB vs. CRT upgrade from right ventricular stimulation was evaluated on Cardiac events at 5 years (p=n.s.). Primary cardiac resynchronization therapy implantation for LBBB resulted in similar 5-year cardiac event rates compared to CRT upgrades from right ventricular stimulation (53% vs 55%, P=n.s.).
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