1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland.
Department of Cardiology, Henryk Klimontowicz Specialist Hospital, Gorlice, Poland.
Kardiol Pol. 2019;77(3):371-379. doi: 10.5603/KP.a2019.0032. Epub 2019 Feb 25.
Left bundle branch block (LBBB) is an important qualification criterion and determinant of prognosis in cardiac resynchronisation therapy (CRT) patients.
Our goal was to investigate the long-term mortality and morbidity in a sizable cohort of patients with CRT with regard to the new strict LBBB definition proposed by Perrin.
We performed a longitudinal cohort study that included consecutive CRT patients. Primary endpoint (all-cause death) and secondary endpoint (all-cause death and hospitalisation for heart failure) were analysed. All preimplantation elec- trocardiograms were categorised as LBBB or non-LBBB according to the new definitions/criteria analysed.
The survival analysis comprised 552 patients with CRT. The Perrin criteria, CRT guidelines class I indication criteria, and Strauss criteria were fulfilled in 38.9%, 79.4%, and 62.3% of all LBBB patients, respectively. During the nine-year study period, 232 patients died and the combined endpoint was met by 292 patients. The Perrin "true LBBB" definition criteria were inferior to the Strauss "complete" LBBB definition criteria in predicting survival as reflected by Kaplan-Meier survival curves (C-statistics). Multivariate Cox regression models showed that both LBBB definitions predicted mortality, however, the Perrin definition had a higher hazard ratio (HR 0.67) compared to the Strauss definition (HR 0.51).
It seems that the Perrin "true LBBB" criteria are not well-suited for the selection of CRT candidates. Perhaps they do not reflect the presence of a true/complete LBBB or exclude too many patients who, despite some residual conduction in the left bundle branch, responded well to CRT.
左束支传导阻滞（LBBB）是心脏再同步治疗（CRT）患者的重要资格标准和预后决定因素。
我们的目标是根据 Perrin 提出的新的严格 LBBB 定义，研究 CRT 大量患者的长期死亡率和发病率。
我们进行了一项包含连续 CRT 患者的纵向队列研究。主要终点（全因死亡）和次要终点（全因死亡和心力衰竭住院）进行了分析。所有植入前心电图根据分析的新定义/标准分为 LBBB 或非 LBBB。
生存分析包括 552 例 CRT 患者。Perrin 标准、CRT 指南 I 类适应证标准和 Strauss 标准分别满足于所有 LBBB 患者的 38.9%、79.4%和 62.3%。在九年的研究期间，232 名患者死亡，292 名患者达到联合终点。Perrin 的“真正 LBBB”定义标准在预测生存率方面不如 Strauss 的“完全”LBBB 定义标准，反映在 Kaplan-Meier 生存曲线（C 统计量）上。多变量 Cox 回归模型显示，两种 LBBB 定义都预测死亡率，但 Perrin 定义的危险比（HR 0.67）高于 Strauss 定义（HR 0.51）。
似乎 Perrin 的“真正 LBBB”标准不太适合 CRT 患者的选择。也许它们不能反映真正/完全性 LBBB 的存在，或者排除了太多尽管左侧束支仍有一些残余传导，但对 CRT 反应良好的患者。
