Service de cardiologie et maladies vasculaires, hôpital Pontchaillou/CHU, 35000 Rennes, France; Service de cardiologie, centre hospitalier, 10, rue Marcel-Proust, 22000 Saint-Brieuc, France.
Service de chirurgie cardiaque, thoracique et vasculaire, hôpital Pontchaillou/CHU, 35000 Rennes, France; Faculté de médecine, université de Rennes 1, 35000 Rennes, France; LTSI Inserm U1099, 35000 Rennes, France.
Arch Cardiovasc Dis. 2017 Dec;110(12):667-675. doi: 10.1016/j.acvd.2017.03.007. Epub 2017 Sep 28.
Left bundle branch block (LBBB) induces mechanical dyssynchrony that may lead to left ventricular systolic dysfunction.
To evaluate the incidence, predictors and clinical impact of new LBBB in patients undergoing surgical aortic valve replacement (SAVR).
After exclusion of patients with pre-existing LBBB, a previous pacemaker or a paced rhythm at hospital discharge, 547 consecutive patients undergoing SAVR were included. All-cause death, cardiovascular death and the combined outcome of all-cause death or a first heart failure event were assessed at 3months and 1year. Patients with and without new LBBB were compared.
New LBBB occurred in 4.6% of patients after SAVR (compared with 16.4% of patients treated by transcatheter aortic valve implantation during the study period). Previous valve surgery and an immediate postoperative paced rhythm were independent predictors of new LBBB. At 1-year follow-up, there were no significant differences in all-cause death, cardiovascular death, or the combined outcome of all-cause death or a first heart failure event between patients with and without new LBBB. However, new LBBB was associated with a trend towards functional deterioration and more heart failure events at 1year.
At 1-year follow-up, new LBBB did not have a significant impact on clinical outcome, but was associated with worse functional status and more heart failure events.
左束支传导阻滞（LBBB）可引起机械不同步，从而导致左心室收缩功能障碍。
评估接受外科主动脉瓣置换术（SAVR）的患者中新出现的 LBBB 的发生率、预测因素和临床影响。
排除术前存在 LBBB、既往起搏器或出院时起搏节律的患者后，纳入 547 例连续接受 SAVR 的患者。在 3 个月和 1 年时评估全因死亡、心血管死亡以及全因死亡或首次心力衰竭事件的联合终点。比较有和无新 LBBB 的患者。
SAVR 后有 4.6%的患者发生新 LBBB（而同期行经导管主动脉瓣植入术治疗的患者中有 16.4%）。既往瓣膜手术和术后即刻起搏节律是新 LBBB 的独立预测因素。在 1 年随访时，有和无新 LBBB 的患者在全因死亡、心血管死亡或全因死亡或首次心力衰竭事件的联合终点方面无显著差异。然而，新 LBBB 与 1 年时功能恶化和心力衰竭事件增多相关，呈趋势性。
在 1 年随访时，新 LBBB 对临床结局没有显著影响，但与更差的功能状态和更多的心力衰竭事件相关。
