Cardiac magnetic resonance–derived myocardial scar is associated with echocardiographic response and clinical prognosis of left bundle branch area pacing for cardiac resynchronization therapy

Chen, Zhongli; Ma, Xuan; Gao, Yuan; Wu, Sijin; Xu, Nan; Chen, Feng; Song, Yanyan; Li, Chongqiang; Lu, Minjie; Dai, Yan; Gold, Michael R; Zhao, Shihua; Chen, Keping

doi:10.1093/europace/euad326

Cited by 3 publications

(2 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in contrast to our results, this research demonstrated that septal scarring was more prevalent in patients with LBBB. 17 Our work supports the absence of a relationship between left ventricular fibrosis and conduction abnormalities. This was applicable to both segmental fibrosis (including septal fibrosis), as well as overall fibrosis, suggesting that QRS prolongation and ventricular fibrosis are distinct entities in patients with HF.…”

Section: Discussionsupporting

confidence: 81%

CMR characterization of patients with heart failure and left bundle branch block

Tomoaia,

Harrison,

Bevis

et al. 2024

European Heart Journal - Imaging Methods and Practice

View full text Add to dashboard Cite

Aims We aimed to identify the distinctive cardiovascular magnetic resonance (CMR) features of patients with left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology. The secondary aim was to determine whether these individuals exhibit characteristics that could potentially serve as predictors of left ventricular ejection fraction (LVEF) recovery as compared to patients without LBBB. Methods We prospectively recruited patients with HFrEF (LVEF ≤40%) on echocardiography who were referred for early CMR examination. Patients with an established diagnosis of coronary artery disease and known structural or congenital heart disease were excluded. LV recovery was defined as achieving ≥10% absolute improvement to ≥40% in LVEF between baseline evaluation to CMR. Results A total of 391 patients were recruited including 115 (29.4%) with LBBB. Compared to HF patients without LBBB, those with LBBB exhibited larger left ventricles and smaller right ventricles, but no differences were observed with respect to LVEF (35.8 ± 12 vs. 38 ± 12 %, p=0.105). The overall rate of LV recovery from baseline echocardiogram to CMR (70 [42 - 128] days) was not significantly different between LBBB and non-LBBB patients (27.8% vs. 31.5%, p=0.47). Reduced LVEF remained an independent predictor of LV non-recovery only in patients with LBBB. Conclusion Patients presenting with HFrEF and LBBB had larger LV cavities and smaller RV cavities than those without LBBB but no difference in prevalence of scar or ischaemia. The rates of LV recovery were similar between both groups, which supports current guidelines to defer device therapy until 3-6 months of GDMT, rather than early CMR and device implantation.

show abstract

Section: Discussionsupporting

confidence: 81%

CMR characterization of patients with heart failure and left bundle branch block

Tomoaia,

Harrison,

Bevis

et al. 2024

European Heart Journal - Imaging Methods and Practice

View full text Add to dashboard Cite

show abstract

“… 38 Notably, a lower scar burden has been identified as a strong predictor of LBBAP response, and pre-procedure cardiac magnetic resonance scar evaluation is proposed as an informative tool for assessing LBBAP CRT responders. 39 Additionally, intracardiac echocardiography–guided implantation during proximal LBBAP has been proposed to reduce procedure time and improve success rates. 40 …”

Section: Outline Of Conduction System Pacing (Hbp and Lbbap)mentioning

confidence: 99%

Enhancing cardiac pacing strategies: a review of conduction system pacing compared with right and biventricular pacing and their influence on myocardial function

Mirmaksudov,

Ross,

Kongsgård

et al. 2024

European Heart Journal - Cardiovascular Imaging

View full text Add to dashboard Cite

Traditional right ventricular pacing has been linked to the deterioration of both left ventricular diastolic and systolic function. This worsening often culminates in elevated rates of hospitalization due to heart failure, an increased risk of atrial fibrillation, and increased morbidity. While biventricular pacing has demonstrated clinical and echocardiographic improvements in patients afflicted with heart failure and left bundle branch block, it has also encountered significant challenges, such as a notable portion of non-responders and procedural failures attributed to anatomical complexities. In recent time, the interest has shifted towards conduction system pacing, initially His bundle pacing and more recently left bundle branch area pacing, as promising alternatives to the established methods. In contrast to other approaches, conduction system pacing offers the advantage of fostering more physiological and harmonized ventricular activation by directly stimulating the His-Purkinje network. This direct pacing results in a more synchronized systolic and diastolic function of left ventricle compared to right ventricular pacing and biventricular pacing. Of particular note is conduction system pacing’s capacity to yield shorter QRS, conserve left ventricular ejection fraction, and reduced rates of mitral and tricuspid regurgitation when compared to right ventricular pacing. The efficacy of conduction system pacing has also been found to have better clinical and echocardiographic improvement than biventricular pacing in patients requiring cardiac resynchronization. This review will delve into myocardial function in conduction system pacing compared to right ventricular pacing and biventricular pacing.

show abstract

A Comparison of the Association of Septal Scar Burden on Responses to LBBAP-CRT and BVP-CRT

Chen,

Ma,

et al. 2024

JACC: Clinical Electrophysiology

View full text Add to dashboard Cite

Cardiac magnetic resonance–derived myocardial scar is associated with echocardiographic response and clinical prognosis of left bundle branch area pacing for cardiac resynchronization therapy

Cited by 3 publications

References 38 publications

CMR characterization of patients with heart failure and left bundle branch block

CMR characterization of patients with heart failure and left bundle branch block

Enhancing cardiac pacing strategies: a review of conduction system pacing compared with right and biventricular pacing and their influence on myocardial function

A Comparison of the Association of Septal Scar Burden on Responses to LBBAP-CRT and BVP-CRT

Contact Info

Product

Resources

About