Faculty Information |
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Article types | Original article |
Language | English |
Refereed paper | Refereed |
Title | Comparative long-term outcomes after cardiac resynchronization therapy in right ventricular paced patients versus native wide left bundle branch block patients. |
Journal | Formal name:Heart rhythm : the official journal of the Heart Rhythm Society Abbreviation:Heart Rhythm ISSN code:1556-3871(Electronic)1547-5271(Linking) |
Volume, Number, Page | 13(2),pp.511-8 |
Papers・Author | Tayal Bhupendar, Gorcsan John, Delgado-Montero Antonia, Goda Akiko, Ryo Keiko, Saba Samir, Risum Niels, Sogaard Peter |
Publication date | 2016/02 |
Papers・Description | BACKGROUND:The current guidelines do not clearly state when we should upgrade a patient with right ventricular pacing (RVP) to cardiac resynchronization therapy (CRT), although the deleterious effect of chronic RVP has been established with recent trials.OBJECTIVES:The aims of this study were to compare the long-term survival after CRT in patients upgraded from RVP withOBJECTIVES:that in patients with left bundle branch block (LBBB) with QRS duration ≥ 150 ms and to compare the mechanical properties associated with CRT response in these groups.METHODS:Overall, 135 patients with implanted CRT from a single center (85 (63%) with native wide LBBB and 50 (37%) with RVP) were studied prospectively. Baseline left ventricular typical contraction pattern was determined using speckle tracking echocardiography in the apical 4-chamber view. The predefined end point was death, heart transplantation, or left ventricular assist device implantation over a period of 4 years.RESULTS:Patients with RVP had a significantly favorable long-term outcomes with adjusted hazard ratio of 0.36 (95% confidence interval 0.14-0.96; P = .04). Both groups had ~70% of patients with typical contraction pattern. The absence of typical contraction pattern was associated with a higher risk of an end point with adjusted hazard ratio of 5.43 (95% confidence interval 2.31-12.72; PRESULTS:<RESULTS:.001). In patients with typical contraction pattern, activation of the apical septal segment occurred more frequently in the RVP group and of the base or mid septal segments in the LBBB group.CONCLUSION:Patients with HF upgraded from RVP have more favorable long-term outcomes after CRT than do native LBBB patients with QRS duration ≥ 150 ms. Contraction pattern assessment can be used to identify potential responders in the RVP group. |
DOI | 10.1016/j.hrthm.2015.11.001 |
PMID | 26545939 |