Author + information
- Received June 16, 2016
- Revision received August 15, 2016
- Accepted August 26, 2016
- Published online October 2, 2017.
- Ivan Stankovic, MDa,b,
- Christian Prinz, MD, PhDc,
- Agnieszka Ciarka, MD, PhDa,
- Ana Maria Daraban, MDa,d,
- Yujing Mo, MDe,
- Marit Aarones, MD, PhDf,
- Mariola Szulik, MDg,
- Stefan Winter, MDh,
- Aleksandar N. Neskovic, MD, PhDb,
- Tomasz Kukulski, MD, PhDg,
- Svend Aakhus, MD, PhDf,i,
- Rik Willems, MD, PhDa,
- Wolfgang Fehske, MD, PhDh,
- Martin Penicka, MD, PhDe,
- Lothar Faber, MD, PhDb and
- Jens-Uwe Voigt, MD, PhDa,∗ ()
- aDepartment of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium
- bDepartment of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- cDepartment of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
- dDepartment of Internal Medicine and Gastroenterology, Clinical Emergency Hospital, University of Medicine and Pharmacy “Carol Davila,” Bucharest, Romania
- eCardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- fDepartment of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- gDepartment of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University-Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
- hKlinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
- iFaculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- ↵∗Address for correspondence:
Prof. Dr. Jens-Uwe Voigt, Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.
Objectives The aim of this study was to compare the volumetric response and the long-term survival after cardiac resynchronization therapy (CRT) in patients with intrinsic left bundle branch block (LBBB) versus chronic right ventricular pacing (RVP) with respect to the presence of mechanical dyssynchrony (MD).
Background Chronic RVP induces an iatrogenic LBBB and asynchronous left ventricular contraction that is potentially reversible by upgrading to CRT.
Methods A total of 914 patients eligible for CRT (117 with conventional pacemakers and 797 with intrinsic LBBB) were included in the study. MD was visually assessed before CRT and was defined as the presence of either apical rocking and/or septal flash on baseline echocardiograms. Patients with a left ventricular end-systolic volume decrease of ≥15% during the follow-up were considered responders. Patients were followed for all-cause mortality during the median follow-up of 48 months (interquartile range: 29 to 66 months).
Results MD was observed in 51% of patients with RVP versus 77% in patients with intrinsic LBBB (p < 0.001). Patients with RVP and MD had a similar likelihood of volumetric response as did patients with intrinsic LBBB and MD (adjusted odds ratio: 0.71; 95% confidence interval: 0.33 to 1.53; p = 0.385). There was no significant difference in long-term survival between patients with RVP and intrinsic LBBB (adjusted hazard ratio: 1.101; 95% confidence interval: 0.658 to 1.842; p = 0.714). Patients with visual MD and either intrinsic LBBB or RVP had a more favorable survival than those without MD (p < 0.001).
Conclusions The likelihood of volumetric response and a favorable long-term survival of patients with RVP was similar to those of patients with intrinsic LBBB and were mainly determined by the presence of MD and not by the nature of LBBB.
- apical rocking
- cardiac resynchronization therapy
- mechanical dyssynchrony
- right ventricular pacing
- septal flash
Dr. Stankovic was supported by a research grant from the European Association of Cardiovascular Imaging. Dr. Daraban was supported by a research grant from the European Heart Failure Association. Dr. Neskovic is partially supported by a grant (175099) of the Ministry of Science, Republic of Serbia. Dr. Willems has received research funding from Biotronik, Boston Scientific Belgium, and Medtronic Belgium; has received speaker and consultancy fees from and participated in clinical trials by different manufactures of cardiac implantable electronic devices (Medtronic, Boston Scientific, Biotronik, St. Jude Medical, Sorin); and is supported as a clinical researcher by the Fund for Scientific Research Flanders. Dr. Voigt is supported by a research grant of the University Hospitals Leuven (OT/12/085); and holds a personal research mandate from the Flemish Research Foundation (1832912N). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 16, 2016.
- Revision received August 15, 2016.
- Accepted August 26, 2016.
- 2017 American College of Cardiology Foundation