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Do all intra-ventricular conduction defect ECG patterns respond equally to CRT?

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Abstract

Purpose

Response to cardiac resynchronization therapy (CRT) is well-established in patients with typical left bundle branch block (LBBB) but modest or even negative in those with intraventricular conduction delay (IVCD). However, IVCD pattern is heterogeneous, and it is possible that QRS patterns may also respond to CRT.

Methods

Consecutive baseline ECGs of 239 patients implanted between 2007 and 2010 with CRT were analyzed. ECGs were classified into the following three groups: (a) typical LBBB (TLBBB) according to accepted guidelines (n = 67); (b) IVCD with LBBB pattern criteria in V1, 1, and aVL but with QS or rS in V5–V6 which we defined as atypical LBBB (ALBBB) (n = 74); and (c) all other IVCD (OIVCD) patterns (n = 98). Endpoints were 2 years mortality and echocardiographic response, defined as a decrease of ≥ 10% in indexed LVESV or an increase of ≥ 5% in left ventricular ejection fraction at 1 year of follow-up.

Results

Baseline clinical characteristics were similar among all the three groups. Rates of echocardiographic response were lower among those with OIVCD compared to those with LBBB and ALBBB (50% vs. 75% and 72%, respectively, p = 0.01 for both comparisons). A multivariable model showed a lower likelihood of echocardiographic response in OIVCD [HR = 0.40; (0.16–0.98)] and a similar likelihood in ALBBBB [HR = 0.98; (0.40–2.40)] compared to TLBBB. Cumulative 2-year survival was 88% in ALBBB, 86% in TLBBB, and 76% in OIVCD (p value = 0.011).

Conclusion

Patients with ALBBB may have a favorable echocardiographic response to CRT and display similar survival rates to typical LBBB. This subgroup of IVCD should be considered for CRT.

Condensed abstract

Atypical left bundle branch morphology defined as QS or rS in lead V1, broad R waves in lead I, and aVL but with QS or rS in V5–V6 is associated with favorable echocardiographic response to CRT and displays similar survival rates to typical LBBB patients.

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Author notes

  1. Avi Sabbag and Yonatan Morag contributed equally to the manuscript.

Authors and Affiliations

  1. The Heart Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Avi Sabbag, Yonatan Morag, Roy Beinart, Stefan Bogdan, Raphael Kuperstein, Micha S. Feinberg, Michael Eldar, Ilan Goldenberg & Eyal Nof

  2. The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel

    Michael Glikson

  3. Davidai Arrhythmia Center Sheba Medical Center, 5265601, Ramat Gan, Israel

    Eyal Nof

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  1. Avi Sabbag
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Sabbag, A., Morag, Y., Beinart, R. et al. Do all intra-ventricular conduction defect ECG patterns respond equally to CRT?. J Interv Card Electrophysiol 58, 87–94 (2020). https://doi.org/10.1007/s10840-019-00589-w

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  • DOI: https://doi.org/10.1007/s10840-019-00589-w

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