Comparison of Incidence of Left Ventricular Systolic Dysfunction Among Patients With Left Bundle Branch Block Versus Those With Normal QRS Duration

Sze, Edward; Dunning, Allison; Loring, Zak; Atwater, Brett D.; Chiswell, Karen; Daubert, James P.; Kisslo, Joseph; Mark, Daniel B.; Velázquez, Eric J.; Samad, Zainab

doi:10.1016/j.amjcard.2017.08.003

Cited by 29 publications

(21 citation statements)

References 26 publications

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“…However, the possibility of underlying silent cardiac conditions, such as reduced left ventricular function without symptomatic heart failure, cannot be excluded. Nevertheless, in a previous retrospective study of patients with LBBB (n = 94) and preserved ejection fraction [13] , functional decline measured by change of left ventricular ejection fraction in transthoracic echocardiogram was found in over one third of the patients. Our results are similar demonstrating that approximately half of all subjects with LBBB but without symptomatic prevalent HF at baseline develop symptomatic HF over a long period of time.…”

Section: Discussionmentioning

confidence: 86%

“…IVCDs are frequent in patients with structural heart disease (SHD) [12] , including valvular heart diseases and cardiomyopathies, but no prior prospective population studies have related IVCDs to novel SHD in subjects without known heart disease. Studies conducted in recent years have evaluated the role of LBBB in inducing left ventricular systolic decline [13] , [14] , while RBBB should play no significant negative role in this aspect [15] . Non-specific IVCD has previously been associated with cardiovascular (CV) mortality [16] and sudden cardiac death [17] , [18] , but the progression to HF has not been extensively studied in patients without overt cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

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Relation of intraventricular conduction delay to risk of new-onset heart failure and structural heart disease in the general population

Rankinen

Haataja

Lyytikäinen

et al. 2020

IJC Heart & Vasculature

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Highlights Subjects with high-risk of developing heart failure ought to be identified. Non-specific IVCD and LBBB were associated with risk of new-onset heart failure. LBBB also carried a risk of novel structural heart disease in 15-year follow-up. Their presence should alert clinician even in subjects free of any known heart disease. Right bundle branch block and other blocks were not associated with increased risk.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Relation of intraventricular conduction delay to risk of new-onset heart failure and structural heart disease in the general population

Rankinen

Haataja

Lyytikäinen

et al. 2020

IJC Heart & Vasculature

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“…If the level of block exists within the proximal HB affecting only the left bundle fibres, pacing the distal HB beyond this block before the fibres branch to take separate anatomical courses will bypass the level of block and restore normal QRS width. LBBB is more than a cosmetic aberration that coexists with another pathology; it may actually be causative in the development of cardiomyopathy,6 thus the renewed interest in its correction.…”

Section: Answermentioning

confidence: 99%

Pacing: a new look. Don’t be deceived

Chow¹,

Baker

Mohamed³

2018

Heart

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CLINICAL INTRODUCTION: A 78-year-old man presents following a syncopal episode in the setting of intermittent sinus bradycardia and left bundle branch block (LBBB). With symptoms likely due to documented intermittent sinus node dysfunction, and finding of a diseased left bundle, a pacemaker was inserted (online supplementary figure 1 shows the electrode position in a PA fluroscopy view). His baseline ECG is shown in figure 1A, with a QRS width of 160 ms, and his echocardiogram revealed a left ventricular ejection fraction of 45%. His ECG day 1 postdevice insertion is shown in figure 1B. His device check confirmed excellent function. His QRS width on ECG postdevice insertion is now normalised to 80 ms.DC1SP110.1136/heartjnl-2018-313392.supp1Supplementary file 1 QUESTION: What type of device therapy has this patient received?Biventricular pacing.Right ventricular outflow septal pacing.His bundle pacing.Right ventricular apical pacing. heartjnl;104/18/1491/F1F1F1Figure 1(A) Baseline ECG and (B) day 1 postpacemaker implantation.

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“…LBBB is an electrical conduction delay with associated mechanical dyssynchrony of the left ventricular and it leads to a decrease in systolic function around 35% of the time 5 . His‐bundle pacing (HBP) addresses, in the most physiological sense, the underlying electrical abnormality of LBBB.…”

Section: Introductionmentioning

confidence: 99%

“…3 Prior studies have shown an increased risk of overt cardiovascular disease and mortality with LBBB, with a relative risk ratio of 3.78 between isolated LBBB and development of LVSD. 4,5 In addition, multiple studies have illustrated the impaired response of patients with LBBB and both ischemic and nonischemic cardiomyopathies to guideline-directed medical therapy (GDMT). 6,7 Furthermore, the presence of LBBB is associated with worse mortality in patients with preexisting LVSD.…”

Section: Introductionmentioning

confidence: 99%

His‐bundle pacing: A novel treatment for left bundle branch block‐mediated cardiomyopathy

Singh

Devabhaktuni²,

Ezzeddine

et al. 2020

Cardiovasc electrophysiol

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Background: Chronic left bundle branch block (LBBB) can lead to LBBB-mediated cardiomyopathy from left ventricular dysynchrony. His-bundle pacing (HBP) results in direct electrical synchrony using the native His-Purkinje system, providing a novel treatment for this cardiomyopathy. Objective: To assess the feasibility of HBP for cardiac resynchronization therapy (CRT) in LBBB-mediated cardiomyopathy patients. Methods: Retrospective database review was conducted on patients who underwent CRT by the HBP capable provider at Indiana University Health and Eskenazi Hospital from August 2015 to August 2017. A subset of patients who met the predefined syndrome criteria of LBBB-mediated cardiomyopathy who underwent HBP were identified. Clinical, echocardiographic, and electrocardiographic variables were extracted at baseline and follow-up. Results: Nine patients had cardiomyopathy and LBBB. Among those two were lost to follow-up. Seven patients were included in the analysis. The average time from device implantation to the last follow-up was 14.5 months. Left ventricular ejection fraction improved on average from 25% to 50% (p = .0001). The left ventricular endsystolic dimension decreased from 47 to 37 mm (p = .003) and the left ventricular end-diastolic dimension decreased from 55 to 48 mm (p = .03). QRS duration with HBP-CRT decreased from 152 to 115 ms. New York Heart Association classification improved from an average of 2.7-2. Conclusion: HBP is a viable technique for pursuing CRT in patients with LBBBmediated cardiomyopathy.

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Comparison of Incidence of Left Ventricular Systolic Dysfunction Among Patients With Left Bundle Branch Block Versus Those With Normal QRS Duration

Cited by 29 publications

References 26 publications

Relation of intraventricular conduction delay to risk of new-onset heart failure and structural heart disease in the general population

Relation of intraventricular conduction delay to risk of new-onset heart failure and structural heart disease in the general population

Pacing: a new look. Don’t be deceived

His‐bundle pacing: A novel treatment for left bundle branch block‐mediated cardiomyopathy

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