Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, 13353 Berlin, Germany.
Europace. 2012 Feb;14(2):224-9. doi: 10.1093/europace/eur307. Epub 2011 Sep 22.
Mortality in chronic heart failure (CHF) patients with left bundle branch block (LBBB) is high. Cardiac resynchronization therapy (CRT) reduces symptoms and mortality in CHF patients with LBBB. Whether CRT promotes or prevents ventricular tachycardia (VT)/ventricular fibrillation (VF) remains controversial, however. Therefore, we aimed to analyse arrhythmia-related CRT effects and characterized the VT/VF incidence in CRT-defibrillator patients and matched controls with conventional implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death.
We enrolled 134 patients [110 men, left ventricular ejection fraction (LVEF) 24 ± 8%, 71 coronary artery disease, CRT-ICD 67, conventional ICD matched controls 67, follow-up 31 ± 17 months] and monitored overall survival and the time to a first VT/VF episode. Controls did not have LBBB. They were otherwise matched for age, LVEF, and follow-up duration. Gender and underlying disease did not differ between the groups. Kaplan-Meier analysis revealed more favourable arrhythmia-free survival in CRT-ICD vs. conventional ICD patients [hazard ratio (HR) 2.26, confidence interval (CI) 1.09-4.67, log rank P = 0.023]. The difference persisted in the multivariate Cox regression analysis (HR 3.25, CI 1.18-8.93, P= 0.022). Overall survival was similar in both groups (HR 1.45, CI 0.55-3.82, P = 0.45).
Chronic heart failure patients with LBBB treated with CRT-ICD, experience less and delayed VT/VF episodes compared with matched controls without LBBB receiving conventional ICD. In the long-term, CRT appears to exert antiarrhythmic effects and to attenuate the particularly high arrhythmia-related risk of CHF patients with LBBB. The incremental benefit of adding the ICD option to CRT pacing in LBBB patients appears questionable.
左束支传导阻滞（LBBB）的慢性心力衰竭（CHF）患者死亡率较高。心脏再同步治疗（CRT）可减轻 LBBB 的 CHF 患者的症状和死亡率。然而，CRT 是否促进或预防室性心动过速（VT）/心室颤动（VF）仍存在争议。因此，我们旨在分析心律失常相关的 CRT 效应，并对接受 CRT 除颤器治疗的患者和接受传统植入式心脏复律除颤器（ICD）用于预防心脏性猝死的原发性预防的患者的 VT/VF 发生率进行特征分析。
我们纳入了 134 名患者[110 名男性，左心室射血分数（LVEF）24±8%，71 例冠心病，CRT-ICD 67 例，传统 ICD 匹配对照 67 例，随访 31±17 个月]，并监测总生存率和首次 VT/VF 发作时间。对照组无 LBBB。其他方面，两组在年龄、LVEF 和随访时间上相匹配。两组的性别和基础疾病无差异。Kaplan-Meier 分析显示，CRT-ICD 组的心律失常无事件生存率优于传统 ICD 组[风险比（HR）2.26，置信区间（CI）1.09-4.67，对数秩 P=0.023]。多变量 Cox 回归分析结果一致（HR 3.25，CI 1.18-8.93，P=0.022）。两组的总生存率相似（HR 1.45，CI 0.55-3.82，P=0.45）。
与接受传统 ICD 治疗且无 LBBB 的匹配对照组相比，接受 CRT-ICD 治疗的 LBBB 的慢性心力衰竭患者的 VT/VF 发作更少且更延迟。长期来看，CRT 似乎具有抗心律失常作用，并减轻 LBBB 的 CHF 患者特别高的心律失常相关风险。在 LBBB 患者中，将 ICD 选项添加到 CRT 起搏中的额外获益似乎值得怀疑。
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