Calle S, Coeman M, Demolder A, Philipsen T, Kayaert P, De Buyzere M, Timmermans F, De Pooter J
Department of Cardiology, University Hospital Ghent, Ghent, Belgium.
Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium.
Neth Heart J. 2021 Dec;29(12):643-653. doi: 10.1007/s12471-021-01565-8. Epub 2021 Apr 30.
New-onset left bundle branch block (LBBB) following transcatheter or surgical aortic valve replacement (LBBB) implies a proximal pathogenesis of LBBB. This study compares electrocardiographic characteristics and concordance with LBBB definitions between LBBB and non-procedure-induced LBBB controls (LBBB).
All LBBB patients at Ghent University Hospital between 2013 and 2019 were enrolled in the study. LBBB patients were matched for age, sex, ischaemic heart disease and ejection fraction to LBBB patients in a 1:2 ratio. For inclusion, a non-strict LBBB definition was used (QRS duration ≥ 120 ms, QS or rS in V1, absence of Q waves in V5-6). Electrocardiograms were digitally analysed and classified according to three LBBB definitions: European Society of Cardiology (ESC), Strauss and American Heart Association (AHA).
A total of 177 patients (59 LBBB and 118 LBBB) were enrolled in the study. LBBB patients had more lateral QRS notching/slurring (100% vs 85%, p = 0.001), included a higher percentage with a QRS duration ≥ 130 ms (98% vs 86%, p = 0.007) and had a less leftward oriented QRS axis (-15° vs -30°, p = 0.013) compared to the LBBB group. ESC and Strauss criteria were fulfilled in 100% and 95% of LBBB patients, respectively, but only 18% met the AHA criteria. In LBBB patients, concordance with LBBB definitions was lower than in the LBBB group: ESC 85% (p = 0.001), Strauss 68% (p < 0.001) and AHA 7% (p = 0.035). No differences in electrocardiographic characterisation or concordance with LBBB definitions were observed between LBBB and LBBB patients with lateral QRS notching/slurring.
Non-uniformity exists among current LBBB definitions concerning the detection of proximal LBBB. LBBB may provide a framework for more consensus on defining proximal LBBB.
经导管或外科主动脉瓣置换术后新发左束支传导阻滞（LBBB）提示LBBB的近端发病机制。本研究比较了LBBB与非手术诱导的LBBB对照组（LBBB）之间的心电图特征以及与LBBB定义的一致性。
纳入2013年至2019年在根特大学医院的所有LBBB患者。LBBB患者与LBBB患者按1:2的比例进行年龄、性别、缺血性心脏病和射血分数匹配。纳入时，采用非严格的LBBB定义（QRS时限≥120毫秒，V1导联呈QS或rS型，V5 - 6导联无Q波）。对心电图进行数字分析，并根据三种LBBB定义进行分类：欧洲心脏病学会（ESC）、施特劳斯和美国心脏协会（AHA）。
共纳入177例患者（59例LBBB和118例LBBB）。与LBBB组相比，LBBB患者有更多的外侧QRS切迹/顿挫（100%对85%，p = 0.001），QRS时限≥130毫秒的比例更高（98%对86%，p = 0.007），QRS电轴左偏程度更小（-15°对-30°，p = 0.013）。LBBB患者中分别有100%和95%符合ESC和施特劳斯标准，但只有18%符合AHA标准。在LBBB患者中，与LBBB定义的一致性低于LBBB组：ESC为85%（p = 0.001），施特劳斯为68%（p < 0.001），AHA为7%（p = 0.035）。在有外侧QRS切迹/顿挫的LBBB和LBBB患者之间，未观察到心电图特征或与LBBB定义一致性的差异。
目前LBBB定义在近端LBBB检测方面存在不一致性。LBBB可能为在定义近端LBBB方面达成更多共识提供一个框架。
