Left bundle branch block without a typical contraction pattern is associated with increased risk of ventricular arrhythmias in cardiac resynchronization therapy patients

Shema Bouazzi, Bhupendar Tayal, Thomas Fritz Hansen, Michael Vinther, Joseph Kisslo, John Gorcsan, Jesper Hastrup Svendsen, Peter Søgaard, Samir Saba, Niels Risum

1 Citation (Scopus)

Abstract

Cardiac resynchronization therapy (CRT) reduces the risk of ventricular arrhythmias (VA) in heart failure (HF) patients with left bundle branch block (LBBB) while the effect is less clear among non-LBBB patients. This study aimed to investigate if absence of LBBB features whether by echocardiography or strict ECG criteria would identify patients at risk of developing VA in a cohort with LBBB according to conventional ECG criteria. Two hundred six CRT candidates were prospectively included from 2 centers. Prior to CRT presence of a typical LBBB contraction pattern was identified using longitudinal strain in the apical 4-chamber view. All preimplantation ECGs were categorized as LBBB or non-LBBB according to Strauss´ strict criteria. Primary end-point was defined as any appropriate antitachycardia pacing (ATP) or shock therapy within 2 years after CRT implantation. A total of 129 (63%) patients had a typical LBBB contraction pattern, while 134 (66%) met the strict ECG criteria. Over 2 years, 45 patients (22%) experienced VA. Absence of a typical LBBB contraction pattern was independently associated with an increased risk of VA (hazard ratio ([HR] 1.89; 95% CI 1.04 to 3.44; p: 0.036). Strict LBBB was not independently associated with the occurrence of VA. Fulfilling neither strict ECG nor echocardiographic criteria for LBBB was associated with a 3.3-fold increase in risk of VA ([HR] 3.34; 95% CI 1.75 to 6.94; (p < 0.001). The risk of VA was almost 2-fold higher if a typical LBBB contraction pattern was absent prior to CRT.

Original languageEnglish
JournalThe international journal of cardiovascular imaging
Volume37
Issue number6
Pages (from-to)1843-1851
Number of pages9
ISSN1569-5794
DOIs
Publication statusPublished - Jun 2021

Keywords

  • Bundle-Branch Block/diagnosis
  • Cardiac Resynchronization Therapy
  • Echocardiography
  • Electrocardiography
  • Heart Failure/diagnostic imaging
  • Humans
  • Predictive Value of Tests
  • Treatment Outcome
  • Heart failure
  • Ventricular arrhythmias
  • Cardiac resynchronization therapy
  • 2-Dimensional strain echocardiography
  • Left bundle branch block

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