University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom.
University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom.
Heart Rhythm. 2015 Nov;12(11):2247-55. doi: 10.1016/j.hrthm.2015.06.015. Epub 2015 Jun 9.
Left bundle branch block (LBBB) and dominant R wave in lead V1 (RV1) post-biventricular pacing (BiVp) are associated with better clinical outcomes. However, some patients continue to deteriorate despite these favorable electrocardiographic changes.
We tested the hypothesis that baseline LBBB and post-BiVp RV1 are associated with better cardiac function and clinical outcomes in patients with progressive deterioration in heart failure after BiVp ("clinical nonresponders") than in patients without these electrocardiographic criteria.
Consecutive patients with advanced heart failure and BiVp were included. An increase in R-wave amplitude of over 4.5 times the baseline value was defined as RV1. Clinical outcome was survival free of heart transplantation and/or implantation of mechanical circulatory support.
A total of 179 (100 (56%) with LBBB; 79 (44%) with non-LBBB) patients with advanced heart failure and BiVp were included. Of the 100 patients with LBBB, 67 (67%) developed RV1 (group 1) but 33 (33%) patients did not develop RV1 (group 2). Of the 79 patients with non-LBBB, 49 (62%) developed RV1 (group 3) and the remaining 30 (38%) patients did not develop RV1 (group 4). Changes in left ventricular ejection fraction and left ventricular end-systolic volume index were not significant in group 1, but deteriorated in the other groups (P < .05). The change in left ventricular end-systolic volume index was associated with the change in QRS duration and absence of RV1 (P < .01). Clinical outcome was most favorable in group 1 (LBBB and RV1). Changes in left ventricular ejection fraction, tricuspid annular plane systolic excursion, and right atrial pressure were associated with clinical outcomes.
Despite progressive deterioration in heart failure, patients with LBBB and RV1 post-BiVp demonstrate more stable cardiac function and more favorable clinical outcomes than did patients with non-LBBB with or without RV1 post-BiVp.
左束支传导阻滞（LBBB）和 V1 导联主导 R 波（RV1）在后双心室起搏（BiVp）后与更好的临床结局相关。然而，尽管这些心电图变化有利，一些患者仍继续恶化。
我们检验了如下假设，即在 BiVp 后心力衰竭进行性恶化的患者（“临床无应答者”）中，基线 LBBB 和 BiVp 后 RV1 与更好的心脏功能和临床结局相关，而在没有这些心电图标准的患者中则不然。
连续纳入接受 BiVp 的晚期心力衰竭患者。RV1 的定义为 R 波振幅增加超过基线值的 4.5 倍。临床结局为免于心脏移植和/或机械循环支持植入的生存。
共纳入 179 例（100 例（56%）为 LBBB；79 例（44%）为非 LBBB）接受 BiVp 的晚期心力衰竭患者。在 100 例 LBBB 患者中，67 例（67%）出现 RV1（组 1），但 33 例（33%）患者未出现 RV1（组 2）。在 79 例非 LBBB 患者中，49 例（62%）出现 RV1（组 3），其余 30 例（38%）患者未出现 RV1（组 4）。组 1 左心室射血分数和左心室收缩末期容积指数的变化不显著，但其他组则恶化（P <.05）。左心室收缩末期容积指数的变化与 QRS 持续时间和无 RV1 相关（P <.01）。组 1（LBBB 和 RV1）的临床结局最好。左心室射血分数、三尖瓣环平面收缩期位移和右心房压力的变化与临床结局相关。
尽管心力衰竭进行性恶化，但与非 LBBB 患者相比，BiVp 后出现 LBBB 和 RV1 的患者心脏功能更稳定，临床结局更好，无论这些患者是否在 BiVp 后出现 RV1。
