Kanawati Juliana, Sy Raymond W
Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia.
Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Heart Lung Circ. 2018 Mar;27(3):291-300. doi: 10.1016/j.hlc.2017.09.007. Epub 2017 Oct 6.
Cardiac resynchronisation therapy (CRT) is a cornerstone in the contemporary management of heart failure. The most effective way of predicting response to this therapy remains electrocardiographic (ECG) criteria of electromechanical dyssynchrony. The left bundle branch block (LBBB) pattern is currently the most robust ECG criterion in predicting improvement in symptoms and reduction in mortality. However, recent studies using three-dimensional (3D) mapping and cardiac magnetic resonance imaging (CMR) have demonstrated heterogeneous left ventricular activation patterns in patients with LBBB. This has led to intense debate on the activation pattern of "true LBBB" and resulted in the proposal of stricter criteria for defining LBBB. This review will focus on the definitions and implications of LBBB in the CRT era. At a minimum, the use of stricter ECG criteria appears warranted, and adjunctive pre-implant imaging or mapping may further identify patient-specific electrophysiological patterns that determine response to CRT.
心脏再同步治疗（CRT）是当代心力衰竭管理的基石。预测该治疗反应的最有效方法仍然是基于心电图（ECG）的电机械不同步标准。左束支传导阻滞（LBBB）模式目前是预测症状改善和死亡率降低的最可靠心电图标准。然而，最近使用三维（3D）标测和心脏磁共振成像（CMR）的研究表明，LBBB患者存在异质性左心室激活模式。这引发了关于“真正LBBB”激活模式的激烈辩论，并导致提出了更严格的LBBB定义标准。本综述将聚焦于CRT时代LBBB的定义及其意义。至少，使用更严格的心电图标准似乎是有必要的，植入前的辅助成像或标测可能会进一步识别出决定CRT反应的患者特异性电生理模式。
