无缺血性心脏病的心脏骤停幸存者中的束支传导阻滞
Bundle branch block in cardiac arrest survivors without ischemic heart disease.
作者信息
Holm Julie Terp, Stampe Niels Kjær, Bhardwaj Priya, Jabbari Reza, Gustafsson Finn, Risum Niels, Tfelt-Hansen Jacob, Winkel Bo Gregers
机构信息
Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark.
出版信息
Int J Cardiol Heart Vasc. 2023 Feb 27;45:101188. doi: 10.1016/j.ijcha.2023.101188. eCollection 2023 Apr.
AIMS
Cardiac arrest (CA) survivors with left/right bundle branch block (LBBB/RBBB) and no ischemic heart disease (IHD) have not been previously characterized. The aim of this study was to describe heart failure, implantable cardioverter defibrillator (ICD) therapy and mortality in this population.
METHODS
Between 2009 and 2019 we consecutively identified all CA survivors with a consistent bundle branch block (BBB) defined as a QRS ≥ 120 ms, who had a secondary prophylactic ICD implanted. Patients with congenital and ischemic heart disease (IHD) were excluded.
RESULTS
Among 701 CA-survivors who survived to discharge and received an ICD, a total of 58 (8%) were free from IHD and had BBB; 46 (79%) had LBBB, 10 (17%) had RBBB and 2 (3%) had non-specific BBB (NSBBB). The prevalence of LBBB was 7%. Pre-arrest ECG were available in 34 (59%) patients; 20 patients (59%) had LBBB, 6 (18%) had RBBB, 2 (6%) had NSBBB, 1 had (3%) incomplete LBBB, and 4 (12%) without BBB. At discharge, patients with LBBB had a significantly lower left ventricular ejection fraction (LVEF) than patients with other types of BBB, p < 0.001. During follow-up, 7 (12%) died after a median of 3.6 years (IQR: 2.6-5.1) with no difference between BBB subtypes.
CONCLUSION
We identified 58 CA-survivors with BBB and no IHD. The prevalence of LBBB among all CA-survivors was high, 7%. During CA hospitalization LBBB patients presented with a significantly lower LVEF than patients with other types of BBB (P < 0.001). ICD treatment and mortality did not differ between BBB subtypes during follow-up.
目的
既往未对无缺血性心脏病（IHD）但有左/右束支传导阻滞（LBBB/RBBB）的心脏骤停（CA）幸存者进行特征描述。本研究旨在描述该人群的心力衰竭、植入式心脏复律除颤器（ICD）治疗及死亡率。
方法
在2009年至2019年期间，我们连续识别了所有有持续性束支传导阻滞（BBB）（定义为QRS≥120毫秒）且植入了二级预防性ICD的CA幸存者。排除患有先天性和缺血性心脏病（IHD）的患者。
结果
在701名存活至出院并接受ICD的CA幸存者中，共有58名（8%）无IHD且有BBB；46名（79%）有LBBB，10名（17%）有RBBB，2名（3%）有非特异性BBB（NSBBB）。LBBB的患病率为7%。34名（59%）患者有心脏骤停前的心电图；20名患者（59%）有LBBB，6名（18%）有RBBB，2名（6%）有NSBBB，1名（3%）有不完全性LBBB，4名（12%）无BBB。出院时，LBBB患者的左心室射血分数（LVEF）显著低于其他类型BBB的患者，p<0.001。在随访期间，7名（12%）患者在中位时间3.6年（四分位间距：2.6 - 5.1年）后死亡，BBB各亚型之间无差异。
结论
我们识别出58名有BBB且无IHD的CA幸存者。所有CA幸存者中LBBB的患病率较高，为7%。在CA住院期间，LBBB患者的LVEF显著低于其他类型BBB的患者（P<0.001）。随访期间，ICD治疗和死亡率在BBB各亚型之间无差异。
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