What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with left bundle branch block. Intervention: Ventricular electrical activation delay (VED) <31.2 ms vs. VED ≥31.2 ms. Primary outcome: Heart failure or death (HR 2.34, 95% CI 1.53-3.57, p=<0.001).

What does this research mean for the field?

Baseline ventricular electrical delay <31.2 ms in heart failure patients with left bundle branch block is associated with a higher risk of heart failure or death and a lack of benefit from cardiac resynchronization therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to determine the association of ventricular electrical delay measured by ECG with the response to cardiac resynchronization therapy in left bundle branch block patients.

April 26, 2018Circulation Arrhythmia and Electrophysiology

Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response in Left Bundle Branch Block Patients From the MADIT-CRT Trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy)

Q: What are the key findings of this study?

Baseline ventricular electrical delay <31.2 ms in heart failure patients with left bundle branch block was associated with a higher risk of heart failure or death (HR 2.34; 95% CI 1.53-3.57; P<0.001).

Q: What does this research mean for the field?

Baseline ventricular electrical delay <31.2 ms in heart failure patients with left bundle branch block is associated with a higher risk of heart failure or death and a lack of benefit from cardiac resynchronization therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This study aims to determine the association of ventricular electrical delay measured by ECG with the response to cardiac resynchronization therapy in left bundle branch block patients.

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Key result

Baseline ventricular electrical delay <31.2 ms in heart failure patients with left bundle branch block was associated with a higher risk of heart failure or death (HR 2.34; 95% CI 1.53-3.57; P<0.001).

Why the study?

Does baseline ventricular electrical activation delay (VED) predict response to cardiac resynchronization therapy in heart failure patients with left bundle branch block?

Key Points

This study aims to determine the association of ventricular electrical delay measured by ECG with the response to cardiac resynchronization therapy in left bundle branch block patients.
Analyzed ECGs from the MADIT-CRT trial to measure baseline ventricular electrical delay using a computerized method.
Dichotomized VED values into quartiles and assessed the association with heart failure or death endpoints using multivariate Cox proportional models.
Evaluated hemodynamic changes post-CRT-D implantation with 1-year follow-up echocardiograms.
Patients with VED <31.2 ms had a 35% risk of MADIT-CRT endpoints, while those with VED ≥31.2 ms had a 14% risk (P < 0.001).
The hazard ratio for predicting endpoints in low VED patients was 2.34 (95% CI, 1.53–3.57; P < 0.001).
Higher VED values correlated with beneficial hemodynamic changes, a trend not observed in right bundle branch block patients.

Study Design

Type

Cohort

Multicenter

Yes

Structured PICO

Does baseline ventricular electrical activation delay (VED) predict response to cardiac resynchronization therapy in heart failure patients with left bundle branch block?

Population

Heart failure patients with left bundle branch block from the MADIT-CRT trial

Intervention

Cardiac resynchronization therapy with defibrillator (CRT-D) in patients stratified by baseline ventricular electrical activation delay (VED)

Comparator

Low VED (<31.2 ms) vs High VED (≥31.2 ms)

Outcome

Composite of heart failure or deathcomposite

Main Result

Effect estimate: HR 2.34 (95% CI 1.53-3.57)

Absolute Event Rate: 35% vs 14%

p-value: p=<0.001

A computerized measurement of ventricular electrical activation delay from standard 12-lead ECGs identifies LBBB patients who benefit most from CRT.

Discussion

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Implication

Low VED flags higher event risk among LBBB patients receiving CRT; hypothesis-generating for refined selection and requires prospective validation.

Cite This Study

Plešinger et al. (2018) conducted a cohort in Heart failure with left bundle branch block. Ventricular electrical activation delay (VED) <31.2 ms vs. VED ≥31.2 ms was evaluated on Heart failure or death (HR 2.34, 95% CI 1.53-3.57, p=<0.001). Baseline ventricular electrical delay <31.2 ms in heart failure patients with left bundle branch block was associated with a higher risk of heart failure or death (HR 2.34; 95% CI 1.53-3.57; P<0.001).

synapsesocial.com/papers/6a1c8a5b2cc291e7bf2fee3b https://doi.org/10.1161/circep.117.005719

Topics

Cardiac device therapy Heart failure HFrEF treatment

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Implication

Low VED flags higher event risk among LBBB patients receiving CRT; hypothesis-generating for refined selection and requires prospective validation.

Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response in Left Bundle Branch Block Patients From the MADIT-CRT Trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy)

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response in Left Bundle Branch Block Patients From the MADIT-CRT Trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy)

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider