Bundle branch block patterns, age, renal dysfunction, and heart failure mortality

McCullough, Peter A.; Hassan, Sohail; Pallekonda, Vinay; Sandberg, Keisha R.; Nori, David; Soman, Sandeep; Bhatt, Sonali; Hudson, Michael; Weaver, W. Douglas

doi:10.1016/j.ijcard.2004.10.008

Cited by 57 publications

(57 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although recent studies have highlighted the prognostic value of QRS morphology on mortality in AHF, they did not show consistent result [1][2][3][4]. These conflicting results may be attributed to the heterogeneous nature of AHF and the patients' characteristics enrolled in each study [7].…”

mentioning

confidence: 88%

See 1 more Smart Citation

Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: Data from the Korean Heart Failure (KorHF) Registry

Hong

Kang

et al. 2012

International Journal of Cardiology

View full text Add to dashboard Cite

mentioning

confidence: 88%

“…Conflicting data exist regarding the predictive value of bundle branch block (BBB) patterns for mortality in hospitalized patients with acute heart failure (AHF) [1][2][3][4]. Thus, we aimed to demonstrate the relationship between the BBB patterns and clinical outcomes in hospitalized patients with AHF enrolled in the Korean Heart Failure (KorHF) Registry.…”

mentioning

confidence: 99%

Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: Data from the Korean Heart Failure (KorHF) Registry

Hong

Kang

et al. 2012

International Journal of Cardiology

View full text Add to dashboard Cite

“…Short-term mortality rates were 46.1%, 56.8%, and 57.7%, respectively (P<0.0001). 31 The normal sequence of electric activation is reversed in LBBB, with the direction of septal depolarization proceeding from right to left and the impulse spreading first to the right ventricle and then to the LV. The resulting delay in the inward motion of the lateral wall of the LV depends on the duration of the QRS, with greater duration of the QRS producing more dyssynchronous contraction.…”

Section: Lbbb and Hfmentioning

confidence: 99%

QRS Duration Criteria to Select Patients for Cardiac Resynchronization Therapy

Guglin

Curtis²

2013

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

European Society of Cardiology guidelines recommend the use of cardiac resynchronization therapy (CRT) in patients with symptomatic heart failure (HF) and QRS durations >120 ms 1,2 (Table 1). However, 2 recent meta-analyses by Sipahi et al 6 and Stavrakis et al 7 challenged these recommendations. Both studies found that patients with QRS durations between 120 and 150 ms do not benefit from CRT. Response by Sipahi and Fang on p 435This is a very important conclusion, from both the clinical and financial standpoints. If the conclusions of these meta-analyses are correct, the guidelines should be revised, and the cutoff for QRS duration indicating the need for CRT should be changed from 120 to 150 ms. From the reimbursement standpoint, these analyses would suggest that the cost of CRT devices implanted in patients with QRS durations shorter than 150 ms should not be covered by insurers. Indeed, the authors of the second metaanalysis state that "the decision to routinely recommend CRT for patients with QRS <150 ms may not be justified." Although not in such categorical terms, some societies are already embracing this idea. In fact, in their recently published update, the Heart Failure Society of America, citing one of the abovementioned meta-analyses, 6 definitely recommends CRT only for patients with QRS durations >150 ms (and not because of right bundle-branch block), with severe left ventricular (LV) systolic dysfunction and persistent New York Heart Association (NYHA) functional class II-III symptoms, despite optimal medical therapy. According to the same update, CRT may still be considered for patients with QRS intervals between 120 and 150 ms and severe left ventricular dysfunction who have persistent symptoms on medical treatment. 5 However, the wording "may be considered" reflects the lowest possible strength of recommendation. Despite the high quality of both meta-analyses, as well as of the individual trials included in them, we doubt that such a conclusion is justified.CRT is a unique therapy for patients with HF and prolonged QRS duration. Not only does it induce reverse LV remodeling, it also improves functional status and increases longevity in these patients. 8,9 Unlike any other therapy with the exception of ventricular assist devices, CRT interrupts the progression of the disease and reverses the natural course of HF, 9 even in minimally symptomatic or asymptomatic patients with complete left bundle-branch block (LBBB) and systolic dysfunction. In just 1 year of therapy, LV end-systolic and end-diastolic volume decreases and ejection fraction increases in most patients, especially those with nonischemic cardiomyopathy. There is also a subset of super-responders in whom biventricular pacing leads to restoration of cardiac geometry and (Circ Arrhythm Electrophysiol. 2013;6:429-435.)

show abstract

“…Short-term mortality rates for the subgroups of patients with decompensated HF with QRS <120 ms, right bundle branch block (RBBB) and LBBB were 46.1 %, 56.8 % and 57.7 %, respectively (p<0.0001). 36 Another population-based study of HF patients showed that those with LBBB had features consistent with more severely decompensated HF. Furthermore, even after accounting for these baseline factors and validated predictors of mortality, a LBBB on the presentation ECG conferred a 10 % increased risk of death and a 32 % increase in HF rehospitalisation in long-term follow-up.…”

Section: Cardiac Resynchronisation Therapy and Patients With Right Bumentioning

confidence: 99%

Use of Cardiac Resynchronisation Therapy – Change of Clinical Settings

Looi¹,

Tang²,

Agarwal³

2011

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Heart failure (HF) is a growing and major health burden in western countries. The prevalence of HF is estimated at 1-2 % in the western world, and the incidence approaches 5-10 per 1,000 persons per year. Cardiac resynchronisation therapy (CRT) has been shown in multiple studies to improve HF symptoms, quality of life and improve survivals. 2-6The two landmark studies, Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) and Cardiac ResynchronizationHeart Failure (CARE-HF), established the clinical indications for CRT, which form the basis for consensus international guidelines. [5][6][7] These two trials randomised 2,333 patients in sinus rhythm (SR) with QRS prolongation on surface electrocardiogram (ECG) (≥120 ms), New York Heart Association (NYHA) functional class III and ambulatory class IV HF and a persistently reduced left ventricular ejection fraction (LVEF), despite optimal medical treatment. The trials showed that CRT reduced the risk of death from any cause and hospital admission for worsening HF. 5,6 The effect of left ventricular reverse remodelling from CRT was sustained over time. York Heart Association (NYHA) class III or IV heart failure (HF) symptoms. Ongoing studies aim to expand the use of CRT in patients with asymptomatic or minimal symptoms left ventricular dysfunction. There have been studies that have shown benefit of CRT extended to this group of patients. There have also been different implications of the role of CRT in patients with atrial fibrillation (AF), patients with narrow QRS duration or with right bundle branch block (RBBB) on surface ECG, as well as patients with end-stage renal failure on dialysis therapy. This article aims to review the current body of evidence of expanding use of CRT in these populations.

show abstract

Bundle branch block patterns, age, renal dysfunction, and heart failure mortality

Cited by 57 publications

References 31 publications

Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: Data from the Korean Heart Failure (KorHF) Registry

Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: Data from the Korean Heart Failure (KorHF) Registry

QRS Duration Criteria to Select Patients for Cardiac Resynchronization Therapy

Use of Cardiac Resynchronisation Therapy – Change of Clinical Settings

Contact Info

Product

Resources

About